DISEASES OF THE
GASTROINTESTINAL TRACT
Dr. Zameer pasha
DISEASES OF THE UPPER DIGESTIVE TRACT
• Gastroesophageal Reflux Disease
• Hiatal Hernia
DISEASES OF THE LOWER DIGESTIVE TRACT
• Disorders of the Stomach
• Disorders of the Intestines
GASTROINTESTINAL SYNDROMES
• Eating Disorders: Anorexia and Bulimia
• Gardner’s Syndrome
• Plummer-Vinson Syndrome
• Peutz-Jeghers Syndrome
• Cowden’s Syndrome
Introduction
• Dental health care workers are expected to recognize, diagnose, and
treat oral conditions associated with gastrointestinal diseases, as well
as provide dental care for afflicted individuals
• To provide safe and appropriate dental care, proper diagnosis of oral
manifestations of gastrointestinal disorders, homeostasis, risk of
infection, drug actions and interactions, the patient’s ability to
withstand the stress and trauma of dental procedures.
• Gastrointestinal tract is a primary route for drug administration,
absorption, biotransformation. Many dental patients require drug
therapy in which pharmacokinetic parameters may be altered by
gastrointestinal and hepatobiliary dysfunction.
Gastroesophageal Reflux Disease [GERD]
• One of the most commonly occurring diseases affecting the upper
gastrointestinal tract.
• Gastric contents (chyme) passively move up from the stomach into
the esophagus.
• Heartburn is the cardinal symptom of GERD and is defined as a
sensation of burning or heat that spreads upward from the
epigastrium to the neck.
• Esophagitis, esophageal ulceration, stricture, dysplasia and dysphagia
are noticed.
• Chest pain is seen and can mimic the symptoms of an acute
cardiovascular disorder and is often the impetus for patients seeking
medical care.
• GERD complications include premalignant and malignant conditions
of the esophagus.
Gastroesophageal Reflux Disease [GERD]
• The relaxation of the lower esophageal sphincter for the purpose of
relieving pressure in the stomach (from gas and the ingestion of food)
is called the “burp” mechanism.
• The gastroesophageal junction, which prevents the regurgitation
(retrograde or upward flow) of gastric contents, is composed of an
internal lower esophageal sphincter.
• The exact cause for the incompetence of this sphincter is not known,
but salivary insufficiency, obesity, pregnancy may all cause GERD.
• Oral health considerations: Dysguesia (foul taste), sensitivity, dental
erosion.
• Management : Lifestyle modifications,
•
Omeprazole etc
Hiatus Hernia
• The esophagus passes through the diaphram. This hiatus causes an
anatomic narrowing of the opening of the stomach.
• Some patients have a weakened or enlarged hiatus which causes the a
part of the stomach to herniate into the chest cavity.
• Three types:
– Sliding
– fixed
– complicated.
• Main symptom – chest pain (radiating pain similar to heart attack).
• Other symptoms – dry cough, hiccups and increased contractile force of
the heart.
• Oral manifestations are similar to GERD.
Disorders of the stomach
• Peptic ulcer disease: is a common benign ulceration of the stomach.
• Etiology :
– Genetic
– Increased acid production
– H pylori infection(Helicobacter pylori)
– Cigarette smoking
– Increased stress
Epigastric pain is the most common complaint. Some of them have life
threatening complication like haemorrhage, perforation of lining and
obstruction.
Gastric ulcer – pain aggravated with food
Duodenum ulcer – pain relieved with food
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Dental patient with history of peptic ulcer –
Avoid stress to the patients
Avoid NSAIDs
Anticholinergic drugs taken for ulcers cause dry mouth
Antacids contain Ca, Mg, Al salts which bind with some antibiotics hence
should be avoided.
• Chronic bleeding may lead to anemia hence determining the blood
parameters is very important.
Inflammatory bowel disease
ULCERATIVE COLITIS AND CROHNS DISEASE
• Ulcerative colitis involves the mucosa and submucosa of the colon.
• Crohn’s disease is an inflammatory condition involving all layers of the gut.
• The precise etiology and pathogenesis of ulcerative colitis and Crohn’s
disease are unknown,
• oral signs of inflammatory bowel diseases, include pyostomatitis vegetans,
aphthous ulcerations, cobblestone appearance of the oral mucosa, oral
epithelial tags and folds, gingivitis, persistent lip swelling, lichenoid
mucosal reactions, granulomatous inflammation of minor salivary gland
ducts, candidiasis, and angular cheilitis.
• The hallmark of ulcerative colitis is rectal bleeding and diarrhea. The
frequency of bowel movements and the amount of blood present reflect
the activity of the disease
• The oral changes that occur in ulcerative colitis
cases are nonspecific and uncommon, with an
incidence of less than 8%. Aphthous stomatitis of
the major and minor variety has been reported in
patients with active ulcerative colitis.
• Chronic bleeding can be associated with ulcerative
colitis. Prior to dental procedures, blood studies
that include hemoglobin, hematocrit, and a red
blood cell count should be undertaken to rule out
the presence of anemia.
• Recurrent aphthous ulcers are the most common
oral manifestation of Crohn’s disease.
pyostomatitis vegetans, cobblestone mucosal
architecture, and minor salivary gland duct
pathology represent granulomatous changes that
constitute the hallmark of Crohn’s disease
Gastrointestinal Syndromes
• Anorexia and Bulimia
• Anorexia involves individuals who intentionally starve themselves when
they are already underweight.
• Bulimia nervosa consume large amounts of food during “binge” episodes
in which they feel out of control of their eating, They then try to prevent
weight gain after such episodes by vomiting, using laxatives or diuretics,
dieting, and/or exercising aggressively.
• Both of these disorders seem to be most prevalent in industrialized
societies.
• Anorexia and bulimia are both considered psychiatric disorders with
physical complications.
• The cardinal oral manifestation of eating disorders is severe erosion of the
enamel on the lingual surfaces of the maxillary teeth.
• Examination of the patient’s fingernails may disclose abnormalities related
to the use of fingers to initiate purging.
• Mandibular teeth may be affected but not as severely as the maxillary
teeth. Parotid enlargement may develop as a sequela of starvation.
• The dentist should be aware of a possible eating disorder when these
symptoms are encountered and should take steps to arrange for referral to
other practitioners
• Gardner’s syndrome: consists of intestinal polyposis (which
represents premalignant lesions) and multiple impacted
supernumerary (extra) teeth. Osteomas, epidermoid cysts .
• Plummer-Vinson Syndrome: Iron deficiency with esophageal
stricture and webs.
• Peutz-Jeghers Syndrome: multiple intestinal polyps
throughout the gastrointestinal tract but primarily in the small
intestine. Pigmentation (present from birth) of the face, lips,
and oral cavity is a hallmark of this syndrome