Selected Gastrointestinal Disorders

These are common disorders seen in the acute care setting. A solid understanding of their pathophysiology and treatment is essential.

Heliobacter pylori (H. pylori)

Pathophysiology:
- Bacteria that live in the digestive tract.
- Can cause duodenal or gastric ulcers and gastritis.
- Secretes substances breaking down mucosal gel and stimulates acid production.
- Smoking inhibits bicarbonate secretion, exacerbating the condition.
Treatment:
- Proton Pump Inhibitors (PPIs) like Omeprazole (Prilosec).
- Two antibiotics are often prescribed to treat H. pylori.

Pathophysiology:
- Backward movement of gastric contents into the esophagus.
- Causes inflammation and tissue damage to the esophagus.
Causative Factors:
- Ineffective esophageal sphincter.
- Delayed gastric emptying.
- Increased stomach volume, improper positioning, and increased gastric pressure due to obesity or tight clothing.
Treatment:
- Lifestyle changes.
- H2 receptor blockers and PPIs to suppress acid secretion and promote esophageal healing.

Pathophysiology:
- Motility disorder causing alternating constipation and diarrhea.
- Affected by eating, stress, hormones, and drugs.
Treatment:
- Relieving symptoms and eliminating precipitating factors.
- Regular bulk-forming laxatives.
- Selective serotonin reuptake inhibitors (SSRIs) like Sertraline (Zoloft) or Fluoxetine (Prozac) to relieve abdominal pain and spasms.

Pathophysiology:
- Chronic relapsing inflammatory disorder affecting the GI tract from mouth to anus.
- Commonly affects the distal small intestine and ascending colon.
- Causes inflammatory lesions affecting all bowel wall layers, leading to ulcers, fissures, and fistulas.
- Malabsorption and malnutrition due to inflammation.
Symptoms:
- Continuous or episodic diarrhea, typically liquid or semi-formed and not containing blood.
Treatment:
- NSAIDs, corticosteroids to decrease inflammation.
- Immunosuppressive drugs, vitamins, and antibiotics.