The Dentist's Quick Guide to Medical Conditions

Mea A. Weinberg, Stuart L. Segelnick, Joseph S. Insler, Samuel Kramer

• Publisher: Wiley-Blackwell
• Year: 2015
• Print ISBN:
  9781118710111
• eBook ISBN:
  9781118953099
• Edition: 1
• Topic: Medicine
• Subtopic: Dentistry

With increasing numbers of dental patients being elderly or having medical conditions, it is important for the dentist to understand how these conditions may impact dental treatment. The Dentist's Quick Guide to Medical Conditions presents the relevant information dentists need—symptoms, diagnostic tests, medications prescribed, and dental management—for each disease and condition. Chapters will focus on each major bodily system, including respiratory, cardiovascular, hematologic, endocrine, gastrointestinal, immune, nervous, reproductive, and urinary, as well as chapters on the liver, kidneys, skin, and psychological conditions. Appendices list guidelines for antibiotic prophylaxis, additional conditions requiring antibiotics, and a quick list of diagnostic tests.

Chapter 1
Gastrointestinal disorders

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1. A. Peptic ulcer disease
2. B. Gastroesophageal reflux disease
3. C. Irritable bowel syndrome
4. D. Inflammatory bowel disease (CD and UC)
   1. a. Crohn’s disease
   2. b. Ulcerative colitis
5. E. Diverticular disease
6. F. Acute pancreatitis
7. G. Celiac sprue
8. H. Pseudomembranous colitis
9. References

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A. Peptic ulcer disease

Clinical synopsis

Peptic ulcer disease (PUD) is a general term describing a group of acid-peptic disorders of the upper gastrointestinal (GI) tract including the esophagus, stomach, and duodenum. A peptic ulcer is defined as a circumscribed loss of tissue or break that occurs in the GI mucosa extending through the GI tract smooth muscle. There is an imbalance between gastric acid and pepsin and mucosal defense factors, including prostaglandins, which protect the stomach by increasing the production of gastric mucus and reducing the production of gastric acid.

There are three types of peptic ulcers: gastric ulcer, which occurs in the stomach; duodenal ulcer, which occurs in the duodenum; and esophageal ulcer, which occurs in the esophagus. Most peptic ulcers are asymptomatic; however, the more commonly seen symptoms in symptomatic ulcers are midepigastric pain, dyspepsia (indigestion), nausea, fullness, nocturnal pain, anorexia, and weight loss. One of the distinguishing features of gastric ulcer is the presence of stomach pain after eating. When pain occurs hours after eating or on an empty stomach accompanied with pain at night, it is duodenal ulcer (Peters et al. 2010). The classical epigastric pain in a duodenal ulcer occurs when acid is produced and secreted in the absence of food in the stomach.

The two most common causes of PUD are chronic nonsteroidal anti-inflammatory drugs (NSAIDs) use and Helicobacter pylori (H. pylori), a Gram-negative bacterium, which resides in the GI mucosal lining and in certain individuals can erode the mucosa resulting in ulceration. Even though the majority of duodenal ulcers are caused by H. pylori, only 5–10% will develop ulcers (Malfertheiner et al. 2009; Peters et al. 2010). The definitive diagnosis of PUD is generally made by an upper GI endoscopy (Peters et al. 2010).

Diagnostics/lab values

If it is certain that the ulcer is not caused by chronic NSAID use, a blood test to detect the presence of H. pylori antibodies is a noninvasive test. Although the test has high sensitivity and specificity when lab serology is used, it cannot discriminate if it is a current infection or previous exposure. Additionally, IgG testing may be positive for many years after treatment and eradication of the bacteria. Saliva can also be used but there is low sensitivity and specificity (Meurer and Bower 2002). Urea breath test (UBT) and fecal antigen test are the other preferred methods for diagnosing the presence of H. pylori before administration of antibiotic and antisecretory drugs (Peters et al. 2010). The UBT is utilized to confirm the eradication of H. pylori. Recurrence of H. pylori infection usually is defined by a positive result on urea breath or stool antigen testing six or more months after documented successful eradication therapy (Ables et al. 2007).

Medications

Management of PUD can differ depending upon whether the etiology is NSAID use or H. pylori infection. Antibiotics are used to eradicate H. pylori infection. Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H₂RAs) provide quick pain relief and accelerated healing of the ulcer (Table 1.1). H2 receptor blockers reduce histamine-stimulated gastric acid secretion by competitively inhibiting H₂ receptors on the parietal cells in the stomach. These agents have a limited effect on gastric acid secretion after food ingestion and are effective in healing ulcers in 6–12 weeks. Antacids are used for the treatment of dyspepsia. PPIs provide rapid symptomatic relief with accelerated healing of duodenal ulcers, thus providing the most rapid symptom relief and highest percentage of esophageal healing of all agents used in gastroesophageal reflux disease (GERD) management. They are the drug of choice for patients with frequent daily symptoms, patients with moderate to severe GERD symptoms, patients not responding to H₂RAs, and patients with complicated disease, including Barrett’s esophagus and esophagitis.

Table 1.1 Medications for peptic ulcer disease and gastroesophageal reflux disease.

Generic drug	Brand name
Proton pump inhibitors (PPI)
Dexlansoprazole	Dexilant
Esomeprazole	Nexium
Lansoprazole	Prevacid
Omeprazole	Prilosec
Pantoprazole	Protonix
Rabeprazole	AcipHex
Histamine-2 receptor antagonists (H2RAs)
Cimetidine	Tagamet
Famotidine	Pepcid
Nizatidine	Axid
Ranitidine	Zantac
Prostaglandin supplements
Misoprostol (prevention of gastric and duodenal ulcers due to nonsteroidal anti-inflammatory drugs)	Cytotec
Protective barrier drug
Sucralfate (for healing of duodenal ulcers, not gastric ulcers)	Carafate
Gastrointestinal stimulant drug
Metoclopramide	Reglan

For NSAID-induced peptic ulcer, an H₂ antagonist or PPI is prescribed. Antacids are recommended for the epigastric pain. Antibiotics are not prescribed.

Management of non–NSAID-induced peptic ulcer that is positive to H. pylori includes systemic antibiotics and H₂ antagonists or PPIs. Over the years, resistance to antibiotics is ...

Table of contents

• Cover
• Title page
• Copyright page
• Dedication page
• Contributors
• Foreword
• Preface
• Chapter 1: Gastrointestinal disorders
• Chapter 2: Medical conditions of the respiratory system
• Chapter 3: Disorders of the urinary system
• Chapter 4: Diseases of the endocrine system
• Chapter 5: Disorders of the cardiovascular system
• Chapter 6: Pregnancy, lactation, and oral contraceptives
• Chapter 7: Disorders of the liver and gallbladder
• Chapter 8: Diseases of the neurological system
• Chapter 9: Psychiatric disorders
• Chapter 10: Hematologic disorders and drugs that cause bleeding
• Chapter 11: Blood dyscrasias
• Chapter 12: Musculoskeletal and connective tissue disorders
• Chapter 13: HIV and oral health care
• Chapter 14: Radiation and chemotherapy
• Appendix A: Antibiotic prophylaxis of the dental patient
• Appendix B: Common dental drug interactions
• Appendix C: Summary of tables/boxes
• Appendix D: Interpretation of common laboratory values
• Index
• End User License Agreement