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71ec2. gerd

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  • LES forms normal barrier between positive pressure in stomach and negative pressure in chest  created by increased pressure of LES and crural diaphragm which is attached to the esophagus by the phrenoesophageal ligament

71ec2. gerd 71ec2. gerd Presentation Transcript

  • GASTROESOPHAGEAL REFLUXDISEASEDr Shuaib AnsariAssociate ProfessorMedical Unit IIIDrShuaibAnsari1
  • GERD GERD is one of the most prevalentgastrointestinal disorders Population-based studies show that up to 15% ofindividuals have heartburn and/or regurgitationat least once a week, and 7% have symptomsdaily2DrShuaibAnsari
  •  The normal antireflux mechanisms consist of LES crural diaphragm anatomical location of the gastroesophageal junction belowthe diaphragmatic hiatus.3DrShuaibAnsari
  • ANTI-REFLUX MECHANISM4DrShuaibAnsari
  • 5Pathophysiology:Lower EsophagealSphincter– changes inresting pressure(incompetent LES),abnormal location(hiatal hernia)Excess acid productionDelayed gastricemptyingDecreased mucosalresistance to acid injury
  • 6DrShuaibAnsariCREST syndrome : Calcinosis, Raynauds phenomenon,Esophageal dysfunction, Sclerodactyly, and Telangiectasias.
  • FACTORS ASSOCIATED WITHTHE DEVELOPMENT OF GERD7DrJPShah
  • CLINICAL FEATURES Heartburn: The burning is aggravated by bending, liftingweight, straining or lying down and may be relieved byantacids Regurgitation of sour material into the mouth Dysphagia due to esophageal spasm/stricture Bleeding occurs due to mucosal erosions or Barretts ulcer Many patients with GERD remain asymptomatic Extraesophageal manifestations of GERD : chronic cough, laryngitis,pharyngitis, hoarseness chronic bronchitis, asthma, pulmonary fibrosis, chronicobstructive pulmonary disease, or pneumonia Rapidly progressive dysphagia and weight loss mayindicate the development of adenocarcinoma in Barrettsesophagus8DrShuaibAnsari
  • DrJPShah9
  • 10DrShuaibAnsari
  • COMPLICATIONS Esophagitis Esophageal ulcer Barretts oesophagus Aspiration pneumonia Iron deficiency Anaemia Esophageal stricture Adenocarcinoma of esophagus11DrShuaibAnsari
  • INVESTIGATIONS1. Upper GI Endoscopy: It is the investigation of choice Done to see esophigitis, strictures Barret’s mucosa can be confirmed by biopsy2. Ambulatory 24-hour pH monitoring : Gold Standard fordiagnosis. It shows a sudden decrease in intraesophagealpH from above to below 4.03. Barium swallow and meal : Hiatus hernia4. Esophageal motility test (Esophageal Manometry)5. Bernstein test: A test to find out if heartburn is caused byacid in the esophagus. The test involves dripping a mildacid, similar to stomach acid, through a tube placed in theesophagus and see whether heartburn occurs or not.6. EKG: to rule out CAD12DrShuaibAnsari
  • 13DrJPShah
  • DrShuaibAnsari14Reflux oesophagitis. Thegullet is inflamed andulcerated (small arrows)and there is earlystricturing (large arrow).Barretts oesophagus. Pinkcolumnar mucosa extendsup the gullet. Smallislands of squamousmucosa remain (arrow).
  • MANAGEMENTA. General measure: Weight reduction Cessation of smoking Small volume frequent meals Avoid alcohol, fatty food, caffeine Avoid late night meals Head end of bed should be eleveted to 15degree angle15DrShuaibAnsari
  • B. Medical treatment:1. Liquid antacid: 10-15 ml TID2. H2 receptor antagonists like ranitidine 150mg orallyBD for 6-8 weeks3. PPIs (Proton pump inhibitors): Omeprazole 20-40mg/day; Lansoprazole 15-30mg/day; pantoprazole40mg/day; Esomeprazole 40mg/day for 6-8 weeks4. Metoclopramide or domperidone 10 mg TID(increases lower gastroesophageal tone andpromotes gastric emptying)5. Esophageal strictures: repeated esophagealdilatations6. Anemia: Oral iron, Blood transfusion16DrShuaibAnsari
  • SURGICAL TREATMENT. Surgical resection of stricture Nissen Fundoplication17DrShuaibAnsari
  • I’m worriedand concernedGI symptomsbother me!My whole life isaffectedHeartburndisturbs mysleepI cannot eat anddrink whateverI likeI cannot bendover or exercise
  • ZOPENTDrShuaibAnsari19