GERD is one of the most common gastrointestinal disorders, affecting up to 15% of individuals. It results from backflow of stomach contents into the esophagus, which is normally prevented by the lower esophageal sphincter and other anatomical protections. Symptoms include heartburn and acid regurgitation. Risk factors include hiatal hernia, excess stomach acid production, delayed gastric emptying, and decreased mucosal resistance. Complications include esophagitis, ulcers, Barrett's esophagus, and even esophageal cancer if left untreated. Treatment involves lifestyle changes, antacids, H2 blockers, proton pump inhibitors, and sometimes surgery for complications like strictures.

1. GASTROESOPHAGEAL REFLUX
DISEASE
Dr Shuaib Ansari
Associate Professor
Medical Unit III
DrShuaibAnsari
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2. GERD
 GERD is one of the most prevalent
gastrointestinal disorders
 Population-based studies show that up to 15% of
individuals have heartburn and/or regurgitation
at least once a week, and 7% have symptoms
daily
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3.  The normal antireflux mechanisms consist of
 LES
 crural diaphragm
 anatomical location of the gastroesophageal junction below
the diaphragmatic hiatus.
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4. ANTI-REFLUX MECHANISM
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Pathophysiology:
Lower Esophageal
Sphincter– changes in
resting pressure
(incompetent LES),
abnormal location
(hiatal hernia)
Excess acid production
Delayed gastric
emptying
Decreased mucosal
resistance to acid injury

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CREST syndrome : Calcinosis, Raynaud's phenomenon,
Esophageal dysfunction, Sclerodactyly, and Telangiectasias.

7. FACTORS ASSOCIATED WITH
THE DEVELOPMENT OF GERD
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8. CLINICAL FEATURES
 Heartburn: The burning is aggravated by bending, lifting
weight, straining or lying down and may be relieved by
antacids
 Regurgitation of sour material into the mouth
 Dysphagia due to esophageal spasm/stricture
 Bleeding occurs due to mucosal erosions or Barrett's ulcer
 Many patients with GERD remain asymptomatic
 Extraesophageal manifestations of GERD :
 chronic cough, laryngitis,pharyngitis, hoarseness
 chronic bronchitis, asthma, pulmonary fibrosis, chronic
obstructive pulmonary disease, or pneumonia
 Rapidly progressive dysphagia and weight loss may
indicate the development of adenocarcinoma in Barrett's
esophagus
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11. COMPLICATIONS
 Esophagitis
 Esophageal ulcer
 Barrett's oesophagus
 Aspiration pneumonia
 Iron deficiency Anaemia
 Esophageal stricture
 Adenocarcinoma of esophagus
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12. INVESTIGATIONS
1. Upper GI Endoscopy:
 It is the investigation of choice
 Done to see esophigitis, strictures
 Barret’s mucosa can be confirmed by biopsy
2. Ambulatory 24-hour pH monitoring : Gold Standard for
diagnosis. It shows a sudden decrease in intraesophageal
pH from above to below 4.0
3. Barium swallow and meal : Hiatus hernia
4. Esophageal motility test (Esophageal Manometry)
5. Bernstein test: A test to find out if heartburn is caused by
acid in the esophagus. The test involves dripping a mild
acid, similar to stomach acid, through a tube placed in the
esophagus and see whether heartburn occurs or not.
6. EKG: to rule out CAD
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Reflux oesophagitis. The
gullet is inflamed and
ulcerated (small arrows)
and there is early
stricturing (large arrow).
Barrett's oesophagus. Pink
columnar mucosa extends
up the gullet. Small
islands of squamous
mucosa remain (arrow).

15. MANAGEMENT
A. 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 15
degree angle
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16. B. Medical treatment:
1. Liquid antacid: 10-15 ml TID
2. H2 receptor antagonists like ranitidine 150mg orally
BD for 6-8 weeks
3. PPIs (Proton pump inhibitors): Omeprazole 20-40
mg/day; Lansoprazole 15-30mg/day; pantoprazole
40mg/day; Esomeprazole 40mg/day for 6-8 weeks
4. Metoclopramide or domperidone 10 mg TID
(increases lower gastroesophageal tone and
promotes gastric emptying)
5. Esophageal strictures: repeated esophageal
dilatations
6. Anemia: Oral iron, Blood transfusion
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17. SURGICAL TREATMENT
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 Surgical resection of stricture
 Nissen Fundoplication
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18. I’m worried
and concerned
GI symptoms
bother me!
My whole life is
affected
Heartburn
disturbs my
sleep
I cannot eat and
drink whatever
I like
I cannot bend
over or exercise

19. ZOPENT
DrShuaibAnsari
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