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
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
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
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