Recent advances in GERD management

1. GASTROESOPHAGEAL REFLUX
DISEASE
Dr. Chinamilli Jaahnavi
Postgraduate
MS, Gen.Surgery

2. Anatomy Of Gastroesophageal
Junction

3. LOWER ESOPHAGEAL SPHINCTER
• 3-5cm segment of contracted smooth muscle
• Zone of elevated intra luminal pressure
• Resting tone of 10- 35mmHg(end expiratory)
• Transient Lower Esophageal Sphincter
Relaxations- TLESRs

4. PHRENOESOPHAGEAL LIGAMENT
Pleura
Subpleural (endothoracic) fascia
Phrenoesophageal fascia (of Laimer)
Transversalis (subdiaphragmatic) fascia
Peritoneum

5. Montreal Definition
“A reflux that causes troublesome
symptoms, mucosal injury in the esophagus or
both of these”

6. Prevalence
• 20% US population reported reflux symptoms
occuring atleast weekly
• 44% experience heart burn at least once a
month
• 18% on non prescription drugs for reflux
related symptoms
• 16.2% prevalence in urban adult population
from nothern India

7. SYMPTOMS
Typical symptoms
• Heart burn
• Regurgitation
• Epigastric pain
Atypical symptoms
Chronic cough
Hoarsness
Globus
Dysphagia
Chest pain
Chronic aspiration
Bronchitis
Sinusitis

8. COMPLICATIONS
Stricture
Esophagitis
Ulceration
Barrett’s esophagus
Adenocarcinoma

10. PLUMBING CIRCUIT
STOMACH
LES
ESOPHAGUS

11. Patient Evaluation
• Emperical therapy with Anti-acid medication
• Upper GI endoscopy
• Ambulatory pH monitoring
• Intra luminal Impedance
• Esophageal function study
• Esophagogram
• Gastric emptying study

12. Jameison- DeMeester Score
• Total esophageal acid exposure time
• Upright acid exposure time
• Supine acid exposure time
• Number of episodes of reflux
• Number of episodes of relux lasting more than 5
min
• Duration of the longest reflux episdore
Symptom associated probabilty (SAP)

13. Treatment options
• Lifestyle modifications
• Medical treatment
• Surgical treatment

14. Surgical procedures
• Laparoscopic Nissen fundoplication
• LINX reflux management system
• Transoral incisionless fundoplication (TIF)
• Radiofrequency ablation of LES- Stretta
System

15. LINX Reflux Management Systems
(Torax Medical)

16. Transoral Incisionless Fundoplication
EsophyX Device for TIF (Endogastric Solutions)

17. Radiofrequency Ablation Of LES
STRETTA SYSTEM (Medieri Therapuetics)

18. How To Choose Proper Treatment

19. Thank you