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Gastro - Esophageal Reflux Desease ( GERD )

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GERD is one of the most common desease around the world that effects, Men, Women and Children,

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Gastro - Esophageal Reflux Desease ( GERD )

  1. 1. GERD Dr Aiydarus Ali Ahmed ( Fowzi ) MBBS, MD E-mail: FOWZI_7@HOTMAIL.COM
  2. 2. Gastro-Esophageal,Reflux Disease (GERDl
  3. 3. Definition • Reflux of gastric contents into the esophagus which allows prolonged contact of these contents with the lower esophageal mucosa. It is the most common disorder of the esophagus.
  4. 4. • Alternate names: reflux, acid reflux, reflux esophagitis, acid regurgitation, and heartburn
  5. 5. Etiology and pathogenesis 1. The resting lower esophageal sphincter (LOS) is low and fails to increase when lying flat. 2. Decrease esophageal clearance of acid due to poor esophageal peristalsis. 3. Delayed gastric emptying.
  6. 6. 4. Hiatus hernia may impair the pinchcock mechanism of the diaphragm. 5. The lower esophageal sphincter tone fails to increase when intra abdominal pressure is increased by tight clothes or pregnancy.
  7. 7. Incidence and Background • It is one of the most common conditions affecting the gastrointestinal system. • Anywhere from 36-77% of people have symptoms of GERD (heartburn, regurgitation of acid etc.) spread equally between men and women. • 7% have daily heartburn • 14-20% have weekly heartburn • 15-50% have monthly heartburn • Even children – especially neurodevelopmental disorders – 90%
  8. 8. Pathophysiology of GERD • A complex interaction of many problems can cause reflux: • Esophageal Dysmotility – weak or uncoordinated esophageal contractions (movement) • Inadequate saliva production – seen in smokers, in certain diseases and normally seen during sleep. • Saliva normally “buffers” any acid which is found in the esophagus.
  9. 9. Pathophysiology, cont’d • Impaired resistance of esophageal lining. • LES dysfunction – poorly functioning sphincter muscle allowing acid to wash up into the esophagus • Delayed emptying of the stomach – poor motor function of the stomach (not draining into the intestine) allowing acid to “pool” in the stomach. • Hiatal hernia – allows acid to wash up into the esophagus due to pressure differences between the abdomen and chest. • Loose hiatus muscle fibers causes reflux even without a hiatal hernia.
  10. 10. Factors associated with increase reflux • - Obesity • - Fat, peppermint • - Coffee (Caffeine) • - Anticholinergics • - Nitrates
  11. 11. • - Pregnancy • - Chocolate • - Smoking • - Ca Ch blockers • - Hiatus hernia
  12. 12. Symptoms •Heartburn – burning or tightness behind the sternum or in the epigastric area. •Acid regurgitation – sour or bitter taste in the throat or mouth. •Water brash – a hot sensation in the stomach followed by a large amount of watery liquid in the mouth. •Dysphagia - difficulty swallowing or painful swallowing (odynophagia). The sensation of a lump in the throat or food getting “stuck” after swallowing. •Asthma, laryngitis and chronic cough are unusual symptoms, but can be caused by GERD.
  13. 13. Symptoms • Symptoms typically occur after eating a meal and… • can be especially noticeable with a large meal or spicy foods. • Symptoms may be relieved by antacids. • Symptoms often are worse when lying flat, straining or sleeping.
  14. 14. Symptoms made worse… • Fatty foods, chocolate, coffee, peppermint as well as alcohol and use of tobacco products can cause or worsen symptoms. • Theophylline, Albuterol, and Calcium channel blockers can also cause symptoms of GERD.
  15. 15. Investigations • GERD is a clinical diagnosis & many patients can be treated without investigations:- 1. Endoscopy. to confirm the presence of esophagitis. 2. 24 hour intraluminal pH monitoring of the esophagus. 3. Esophageal manometry. 4. Barium study: It may show a hiatus hernia.
  16. 16. Barium swallow
  17. 17. Upper endoscopy
  18. 18. 24-hr pH Monitoring
  19. 19. Esophageal Manometry
  20. 20. Complications of GERD • Reflux esophagitis • Injury and inflammation of the inner lining of the esophagus from prolonged exposure to acid and digestive enzymes. • This produces pain as well as sometimes painful swallowing (odynophagia) or a “sticking” sensation (dysphagia)
  21. 21. Complications of GERD • Reflux esophagitis can progress to complications: • Long-standing inflammation and scarring can progress to Barrett’s esophagus which is a premalignant condition. • Severe scarring and narrowing of the esophagus can occur called strictures. These can cause food to become “stuck” or can cause pain when swallowing. • Advanced cases can lead to outpouchings of the walls of the esophagus called a diverticula.
  22. 22. Complications of GERD • Barrett’s Esophagus • This is the replacement of the cells lining the esophagus with cells more typical of the stomach or intestines (metaplasia) due to the long-term damage caused by GERD and acid. • Occurs in approx 10% of patients with GERD.
  23. 23. Barrett’s Esophagus • Barrett’s esophagus • Represents one of the more serious complications of GERD. It is a precancerous condition associated with cancer of the esophagus. It is thought to be caused by ongoing injury, inflammation and damage to the lining of the esophagus.
  24. 24. • Anemia • Iron deficiency anemia occurs as a consequence of chronic insidious blood loss from long standing esophagitis
  25. 25. Treament •Treatment of GERD is primarily medical, the mainstays being lifestyle modifications (see Table below) and drug therapy
  26. 26. Treatment, Cont… • The goals of treatment are to provide symptom relief, heal erosive esophagitis, and prevent complications.
  27. 27. Treatment, Cont… I. Simple life style measures 50% of patients can be treated by: o Cessation'et smoking, loss of weight and simple antacids. o Avoid alcohol, fatty meals & drugs e.g. nitrates. o Avoid heavy meals especially before sleep. o Raising the head of the bed at night. o Avoid any other precipitating factor.
  28. 28. Treatment, Cont… II. Pharmacological Therapy I. Drugs reduce gastric acidity: (Prolonged therapy is usually needed) • Antacids: Mg trisilicate and aluminium hydroxide, also alginate containing antacids forming a gel with gastric contents reducing reflux. • H2blockers: Ranitidine (Zantac(ID)(300mg at bed time) • Proton pump inhibitors: Omeprazole (20-40mg/day), Lanzoprazole (30mg/day) or pantoprazole (20- 40mg/day). They inhibit the gastric hydrogen-potassium ATPase .
  29. 29. Treatment , Cont… • Drugs increase esophageal peristalsis and LOS pressure (Prokinetic) • - Cisapride (Prepulsid): not available now!? It leads to arrythmia. • - Metoclopramide or Domperidone.
  30. 30. والسلام عليكم و رحمة الله

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