Dr. Otmani Mohamed

06/02/2026

https://www.facebook.com/share/p/1Dsyxc9HuC/

31/01/2026

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Classification of serrated colon lesions (polyps)

28/01/2026

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🔥 GASTROESOPHAGEAL REFLUX DISEASE (GERD)

⚠️ GERD = symptomatic reflux of gastric contents into the esophagus
➤ Most commonly due to transient LES relaxation
➤ Contributing factors: incompetent LES, gastroparesis, hiatal hernia

⸻

🩺 HISTORY & PHYSICAL

➤ Heartburn ± regurgitation
  30–90 min post-meal
  Worse lying down, better upright/antacids

➤ Uncommon symptoms:
  Sour taste, globus sensation
  Chronic cough, morning hoarseness
  Chest pain (DDx: CAD)

➤ Physical exam usually normal
  Unless systemic disease (eg, scleroderma)

⸻

🚨 ALARM SYMPTOMS

➤ Weight loss
➤ Dysphagia
➤ Melena or hematemesis
➤ Anemia
➤ Odynophagia
➤ Chest pain

⸻

🔬 DIAGNOSIS

➤ Clinical diagnosis
  Empiric treatment if no alarm symptoms

➤ Most accurate test
  24-hr pH monitoring with impedance

➤ EGD + biopsy if:
  Refractory to empiric therapy
  Long-standing symptoms (rule out Barrett)
  Alarm symptoms present

➤ Other tests
  Manometry for refractory cases
  Barium swallow – limited role

⸻

💊 TREATMENT

➤ Lifestyle (ALL patients)
  Weight loss
  Head-of-bed elevation
  Small meals, avoid late meals
  Avoid alcohol, chocolate, coffee

➤ Medical therapy
  Empiric 8-week PPI if no alarm symptoms
  Mild: Antacids
  Chronic: H2 blockers or PPIs
  Severe/erosive: PPIs first

➤ Selected patients
  Fundoplication or anti-reflux procedures

⸻

⚠️ COMPLICATIONS

➤ Erosive esophagitis
➤ Peptic stricture
➤ Aspiration pneumonia
➤ Upper GI bleeding
➤ Barrett esophagus
➤ Adenocarcinoma

⸻

📘 NEW GASTROENTEROLOGY BOOK – NOW AVAILABLE
🔗 www.mediconotes.com

27/01/2026

https://www.facebook.com/share/p/18571wtBeK/

Post prandial Abdominal pain syndromes

25/01/2026

https://www.facebook.com/share/p/17fzCtGcSD/

Complete List of IBD therapy with dose and schedule

25/01/2026

https://www.facebook.com/share/p/1GMrjohk27/

Major malignant GI tumors

ESOPHAGUS

1) Squamous cell carcinoma
• Upper/mid esophagus
• Risks: smoking + alcohol, hot drinks
• Dysphagia + weight loss

2) Adenocarcinoma
• Lower esophagus
• From Barrett (GERD)
• Often near GE junction

⸻

STOMACH

1) Adenocarcinoma
• Risks: H. pylori, smoked/salty food
• Weight loss, early satiety
• Can spread to Virchow node / Krukenberg

2) GIST
• From Interstitial cells of Cajal
• KIT (CD117)+
• Mass can bleed → anemia

3) Leiomyosarcoma
• Malignant smooth muscle tumor
• Large bulky mass, may ulcerate/bleed

⸻

SMALL INTESTINE

1) Adenocarcinoma
• More in duodenum/jejunum
• Risks: Crohn, celiac
• Causes obstruction + weight loss

2) Leiomyosarcoma
• Smooth muscle cancer
• Bleeding + mass effect

3) GIST
• KIT+ mesenchymal tumor
• Bleeding, abdominal mass

4) Carcinoid tumor
• Neuroendocrine (often ileum/appendix)
• Can cause carcinoid syndrome (flushing, diarrhea, wheeze) if liver mets

⸻

LARGE INTESTINE

1) Adenocarcinoma
• Most common colon cancer
• Right: anemia, occult bleed
• Left: obstruction, “pencil stool”
• Risk: polyps, IBD

2) Lymphoma
• From lymphoid tissue
• Seen with immunosuppression
• Abdominal pain + weight loss

⸻

A**S

1) Cloacogenic carcinoma
• At a**l transition zone
• Related to HPV
• Bleeding/pain lump

2) Malignant melanoma
• Dark pigmented a**l mass
• Very aggressive
• Early metastasis

3) Squamous carcinoma
• Most common a**l cancer
• Strong link: HPV (16/18), HIV
• Painful mass, bleeding

⸻

25/01/2026

https://www.facebook.com/share/p/1A7Cq3j7Gn/

💬 Editorial: Among adults with acute uncomplicated , findings from the APPAC trial indicate that antibiotic therapy remains a safe and feasible alternative to .

At 10 years, 44% of patients who initially received antibiotics ultimately required appendectomy, with reduced cumulative complication rates compared to surgery.

Quality of life and patient satisfaction were similar between treatments. Ultimately the decision should be an individual one between patients and clinicians.

https://ja.ma/4bGI9cL

25/01/2026

https://www.facebook.com/share/p/1C17wWRwru/

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease that predominantly affects women ages 40 to 60 years and often co-occurs with other autoimmune disorders.

First-line treatment is ursodeoxycholic acid, improving transplant-free survival rates; elafibranor and seladelpar, recently FDA approved as second-line options, provide additional benefit for patients with inadequate response to ursodeoxycholic acid.

💡 This JAMA Insights discusses the clinical presentation, diagnosis, and treatment of primary biliary cholangitis.

https://ja.ma/3NBoy3V

23/01/2026

How We Approach It: Alfapump
Vargas, et al.

📕 doi.org/10.14309/ajg.0000000000003751