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

    1. 1. GASTROESOPHAGEAL REFLUXDISEASEDr Shuaib AnsariAssociate ProfessorMedical Unit IIIDrShuaibAnsari1
    2. 2. 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
    3. 3.  The normal antireflux mechanisms consist of LES crural diaphragm anatomical location of the gastroesophageal junction belowthe diaphragmatic hiatus.3DrShuaibAnsari
    4. 4. ANTI-REFLUX MECHANISM4DrShuaibAnsari
    5. 5. 5Pathophysiology:Lower EsophagealSphincter– changes inresting pressure(incompetent LES),abnormal location(hiatal hernia)Excess acid productionDelayed gastricemptyingDecreased mucosalresistance to acid injury
    6. 6. 6DrShuaibAnsariCREST syndrome : Calcinosis, Raynauds phenomenon,Esophageal dysfunction, Sclerodactyly, and Telangiectasias.
    7. 7. FACTORS ASSOCIATED WITHTHE DEVELOPMENT OF GERD7DrJPShah
    8. 8. 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
    9. 9. DrJPShah9
    10. 10. 10DrShuaibAnsari
    11. 11. COMPLICATIONS Esophagitis Esophageal ulcer Barretts oesophagus Aspiration pneumonia Iron deficiency Anaemia Esophageal stricture Adenocarcinoma of esophagus11DrShuaibAnsari
    12. 12. 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
    13. 13. 13DrJPShah
    14. 14. 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).
    15. 15. 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
    16. 16. 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
    17. 17. SURGICAL TREATMENT. Surgical resection of stricture Nissen Fundoplication17DrShuaibAnsari
    18. 18. I’m worriedand concernedGI symptomsbother me!My whole life isaffectedHeartburndisturbs mysleepI cannot eat anddrink whateverI likeI cannot bendover or exercise
    19. 19. ZOPENTDrShuaibAnsari19

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