GERD is a common condition where stomach acid refluxes into the esophagus. It affects around 13% of the global population. Risk factors include advancing age, obesity, hiatal hernia, smoking, and certain foods. GERD occurs when there is an imbalance between protective factors in the esophagus and aggressive factors like acid and pepsin from the stomach. Symptoms range from heartburn to complications like esophagitis, stricture, and Barrett's esophagus. Treatment involves lifestyle modifications, antacids, H2 blockers, and PPIs. For severe cases, surgery may be considered to reinforce the lower esophageal sphincter. Endoscopic surveillance is important for monitoring Barrett
5. Epidemiology
• Pooled prevalence – 13%
• prevalence of GERD is highest in South Asia and Southeast Europe
(more than 25%)
• 20% - heartburn/week
• 10% - daily symptoms
6. • No gender difference in Europe
• Complication more in male
• Advancing age (40-60 yrs)
• Obese> non obese
• Race
• H. Pylori associated gastritis
43. Medical measures
Mild to moderate GERD:
• H2RA for 8-12 weeks –if no response
PPI 40mg/day- 8- 12 wks
• Alginate/ Antacid
Severe GERD:
•H2RA in double doses for 8-12wks
PPI – 40 mg/day for 8-12wks
44. Maintenance therpay
PPI in optimum doses- sccessful in >85%
Recurrence within 6 months
• Severe esophagitis-80%
• Milder esophagitis- 15-30%
Maintenance at standard/half doses needed
45. • Mild to Moderate GERD: Step up
General measures + Antacids/ alginate
H2RA in standard doses for 8-12 weeks
PPI in standard doses for 8-12 weeks
46. • Step down therapy :
PPI in standard doses ( 40mg/day)
Maintenance in half doses
if possible
47. Step-III: Surgical treatment:
Indications:
• Failure/ poor response to Mx
• Peptic sricture- frequent dilatation (>3/yr)
• Younger pt with Barrett esophagus (BE)
• Pt with BE having dysplastic changes
• Respiratory complications
• Persistant volume reflux
• Patients desire
59. Barrett esophagus
• Columnar metaplasia of squamous epithelium at lower end of
esophagus
• More common in white male
• Pre-malignant condition
60. Criteria for Barrett esophagus
• Columnar epithelium lines 1 cm or greater of the distal esophagus.
• biopsy specimens shows columnar epithelium
61.
62. It can be categorized
Long segment
Short segment
Prague C and M classification
Circumference
Maximum extent
63. • long-segment Barrett esophagus is found in 3% to 5%
• 10% to 20% have short-segment Barrett esophagus.
64. • The overall incidence of cancer development in patients with non-
dysplastic Barrett esophagus is approximately 0.25% per year.
• Low grade dysplasia to cancer-0 .4%/ year
• High grade dysplasia to cancer- 6%/year
68. Follow-up
• high-grade dysplasia or intramucosal carcinoma in Barrett esophagus,
endoscopic surveillance is performed every 3 months for the first
year, every 6 months in the second year, and annually thereafter.
• Low-grade dysplasia, endoscopic surveillance is performed every 6
months for the first year, and annually thereafter.
69. References
• Sleisenger and Fordtran's Gastrointestinal and Liver Disease
• CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy
• 2013 American College of Gastroenterology guidelines for diagnosis and
management: Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and
management of gastroesophageal reflux disease. Am J Gastroenterol.
2013;108:308–328; quiz 329. Doi: 10.1038/ ajg.2012.444. National Guideline
Clearinghouse NGC 009639.
• World Gastroenterology Organigation guideline
• Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The
Montreal definition and classification of gastroesophageal reflux disease: a
global evidence-based consensus. Am J Gastroenterol 2006;101:1900–20; quiz
1943.
• Moayyedi P, Talley NJ. Gastro-oesophageal reflux disease. Lancet
2006;367:2086–100.
Editor's Notes
GERD usually Dxed symptomatically heartburn 2 Or > days a week.
