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    Gastroesophageal Reflux

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    tofan widya
    GERD is a condition where stomach acid refluxes into the esophagus, causing symptoms like heartburn and regurgitation. It affects 10-20% of people in Western countries. Risk factors include obesity, pregnancy, smoking, large meals, and medications. GERD occurs when the LES does not close properly, allowing gastric contents to rise up into the esophagus. This can cause inflammation and complications over time like erosions, strictures, Barrett's esophagus, and cancer. Diagnosis involves documenting mucosal injury via endoscopy or pH testing to detect acid reflux episodes. Treatment focuses on lifestyle changes, medications like PPIs, and sometimes surgery to reduce acid reflux.

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    Gastroesophageal Reflux

    Uploaded by

    tofan widya
    9 views20 pages
    GERD is a condition where stomach acid refluxes into the esophagus, causing symptoms like heartburn and regurgitation. It affects 10-20% of people in Western countries. Risk factors include obesity, pregnancy, smoking, large meals, and medications. GERD occurs when the LES does not close properly, allowing gastric contents to rise up into the esophagus. This can cause inflammation and complications over time like erosions, strictures, Barrett's esophagus, and cancer. Diagnosis involves documenting mucosal injury via endoscopy or pH testing to detect acid reflux episodes. Treatment focuses on lifestyle changes, medications like PPIs, and sometimes surgery to reduce acid reflux.

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    GASTROESOPHAGEAL REFLUX

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    GERD is a condition where stomach acid refluxes into the esophagus, causing symptoms like heartburn and regurgitation. It affects 10-20% of people in Western countries. Risk factors include obesity, pregnancy, smoking, large meals, and medications. GERD occurs when the LES does not close properly, allowing gastric contents to rise up into the esophagus. This can cause inflammation and complications over time like erosions, strictures, Barrett's esophagus, and cancer. Diagnosis involves documenting mucosal injury via endoscopy or pH testing to detect acid reflux episodes. Treatment focuses on lifestyle changes, medications like PPIs, and sometimes surgery to reduce acid reflux.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    9 views20 pages

    Gastroesophageal Reflux

    Uploaded by

    tofan widya
    GERD is a condition where stomach acid refluxes into the esophagus, causing symptoms like heartburn and regurgitation. It affects 10-20% of people in Western countries. Risk factors include obesity, pregnancy, smoking, large meals, and medications. GERD occurs when the LES does not close properly, allowing gastric contents to rise up into the esophagus. This can cause inflammation and complications over time like erosions, strictures, Barrett's esophagus, and cancer. Diagnosis involves documenting mucosal injury via endoscopy or pH testing to detect acid reflux episodes. Treatment focuses on lifestyle changes, medications like PPIs, and sometimes surgery to reduce acid reflux.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    GASTROESOPHAGEAL

    REFLUX
    DISEASE
    Tutor 2
    Definition
    • Gastroesophageal reflux disease (GERD) as “a condition
    which develops when the reflux of stomach contents causes
    troublesome symptoms and/or complications” (Yamada’s
    Textbook of Gastroenterology).
    • Gastroesophageal reflux resulting
    in either troublesome symptoms
    or an array of potential
    esophageal and extraesophageal
    manifestations. (Harrison)
    EPIDEMIOLOGI
    • Population-based studies show that up to 15% of individuals have
    heartburn and/or regurgitation at least once a week, and 7% have
    symptoms daily.
    • chronic oesophagitis occurring in 30% of the general population.
    • Based on the self-reported prevalence of heartburn, 10%–20% of
    individuals in Western countries have GERD
    • Gender: GERD is equally prevalent among males and females but there is a male
    preponderance of esophagitis (2 : 1 to 3 : 1).
    • Age: The incidence of GERD increases with age; GERD was greatest in the 60–69-year
    range.
    • Pregnancy : half to two-thirds of pregnant women complain of typical GERD symptoms
    • Geographic variation: GERD prevalence is greater in Western countries (10%–20%) than
    in Asia (5%–7%).
    • Lifestyle, environmental factors, and genetic predisposition may influence GERD
    prevalence
    • Obesity: In western countries, the increased prevalence of GERD has occurred in
    parallel with the dramatic increase in obesity.
    • Medications: Several medications (nitrates, calcium channel blockers, anticholinergics,
    α-adrenergic agonists, theophylline, morphine, benzodiazepines, and sumatriptan) have
    been reported to promote GERD occurrence.
    • H. pylori: prevalence of H. pylori has decreased, the prevalence of GERD has increased.
    ETIOLOGI
    Harrison Crash Course

    • Symptoms are caused by backflow Factors associated with GORD are:


    of gastric acid and other gastric 1. Pregnancy or obesity
    contents into the esophagus due to
    incompetent barriers at the 2. Fat, chocolate, coffee or alcohol
    gastroesophageal junction. ingestion
    • Incompetence of the diaphragmatic 3. Large meals
    crural muscle also predisposes to 4. Cigarette smoking
    GERD.
    5. Anticholinergic drugs, calcium
    channel antagonists and nitrate
    RISK FACTOR : drugs
    • Obesity 6. Hiatus hernia
    PATHOPHYSIOLOGY
    • Reflux occurs only when the gradient of pressure between the LES and the
    stomach is lost.
    • caused by a sustained or transient decrease in LES tone.
    • sustained hypotension of the LES may be due to muscle weakness that is
    often without apparent cause.
    • Increased episodes of tLESR are associated with GERD.
    PATHOPHYSIOLOGY
    1. The resting LOS tone is low or absent
    2. The LOS tone fails to increase when lying flat, or when the intra-
    abdominal pressure has increased, e.g. during pregnancy or while
    wearing tight clothing.
    3. Poor oesophageal peristalsis leads to reduced clearance of acid in the
    oesophagus
    4. Hiatus hernia can impair the function of the LOS and the diaphragm
    closure mechanism, as the pressure gradient between the abdominal
    and thoracic cavities is diminished
    5. Delayed gastric emptying increases the chance of reflux.
    Gastric contents are most likely to reflux :
    1. gastric volume is increased
    2. gastric contents are near the gastroesophageal junction
    3. gastric pressure is increased
    Esophageal exposure to refluxed gastric contents
    depends on :
    1. amount of refluxed material per episode
    2. frequency of reflux episodes
    3. rate of clearing of the esophagus by gravity and peristaltic
    contractions

    • Acid refluxed into the esophagus is neutralized by saliva.


    • If the refluxed material extends to the cervical esophagus and crosses
    the upper sphincter, it can enter the pharynx, larynx, and trachea.
    Complication of reflux
    1. Reflux esophagitis, most common esophageal
    mucosal injury (erosions).
    2. Mild esophagitis
    3. Erosive esophagitis
    4. Peptic stricture
    • These may haemorrhage, perforate, or heal by fibrosis
    (sometimes forming a stricture) and epithelial
    regeneration.
    • Barrett’s oesophagus
    • Esophageal adenocarcinoma.
    CLINICAL FEATURES
    • Heartburn
    • Regurgitation of sour material into the mouth
    • Angina-like or atypical chest pain
    • dysphagia
    • woken up at night if refluxed fluid irritates the larynx
    • Bleeding
    • Extraesophageal manifestations : chronic cough, laryngitis, and
    pharyngitis, morning hoarseness, chronic sinusitis .
    • Recurrent pulmonary aspiration : chronic bronchitis, asthma, pulmonary
    fibrosis, chronic obstructive pulmonary disease, or pneumonia.
    DIAGNOSIS
    • In most cases, the diagnosis can be made clinically and no
    investigation is required. In atypical cases, diagnostic approach to
    GERD can be divided into three categories :

     Documentation of mucosal injury


     Documentation and quantitation of reflux
     Definition of the pathophysiology
    Documentation of mucosal injury
    • Barium swallow (reveal an ulcer or a stricture),
    • Esophagoscopy (reveal the presence of erosions,ulcers, peptic
    strictures, or Barrett’s metaplasia with or without ulcer, peptic
    stricture, or adenocarcinoma
    • Mucosal biopsy, show early changes of esophagitis, including dilation
    of intracellular spaces.
    Documentation and quantitation of reflux

    • can be done by long-term esophageal pH recording, using a pH-


    sensitive capsule are helpful only in the evaluation of pharyngeal acid
    reflux.
    • Reflux of nonacid contents can be documented by the use of an
    impedance test.
    Treatment
    • The goals : symptom relief, heal erosive esophagitis, and prevent
    complications.
    • management of mild cases :
    1. weight reduction,
    2. sleeping with the head of the bed elevated by about 4–6 in. with
    blocks
    3. elimination of factors that increase abdominal pressure.
    Non Pharmacology :
    Antireflux surgery
    Prevention : Pharmacology
    • not smoke SYMPTOM RELIEF
    • avoid consuming fatty foods, • H2 receptor antagonists (cimetidine,
    coffee, chocolate, alcohol, mint, 300 mg qid; ranitidine, 150 mg bid;
    orange juice, and certain famotidine, 20 mg bid; nizatidine, 150
    medications (such as mg bid).
    anticholinergic drugs, calcium HEAL EROSIVE ESOPHAGITIS
    channel blockers, and other
    smooth-muscle relaxants) • PPIs : omeprazole (20 mg/d),
    lansoprazole (30 mg/d), pantoprazole
    • Avoid ingesting large quantities
    (40 mg/d), esomeprazole (40 mg/d),
    of fluids with meals or rabeprazole (20 mg/d) for 8 weeks.
    • lifestyle change and over-the- taken 30 min before breakfast.
    counter antisecretory agents.
    Reference :
    • Harison’s Gastroenterology and Hepatology 3 ed
    • Crash Course Gastrointestinal system 4 ed
    • Yamada’s Textbook Gastroenterology 6 ed

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