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1. UNIVERSIDAD TECNICA DE MACHALA
ACADEMIC UNIT OF CHEMICAL
SCIENCES AND HEALTH
MEDICINE SCHOOL
ENGLISH
GERD
STUDENTS
William Cruz
Kevin Herrera
Jorge Pacheco
Angie Chamba
Sonia Quijilema
TEACHER:
Mgs. Barreto Huilcapi Lina Maribel
CLASS:
EIGHTH SEMESTER ‘’A’’
Machala, El Oro
2018

2. GERD
Definition
Gastroesophageal reflux disease occurs when stomach acid usually returns to the tube that
connects the mouth to the stomach (esophagus). This flow in the opposite direction (acid
reflux) can irritate the lining of the esophagus.
Many people suffer from acid reflux every so often. Gastroesophageal reflux disease can be
mild acid reflux, which occurs at least twice a week, or moderate to severe acid reflux,
which occurs at least once a week.
Most people can control the discomfort of gastroesophageal reflux disease with changes in
lifestyle or over-the-counter medications. However, some people with gastroesophageal
reflux disease may need stronger medications or surgery to relieve symptoms.

3. Etiology
When you eat, food passes from the throat to the stomach through the esophagus. A ring of
muscle fibers in the lower part of the esophagus prevents the swallowed food from rising
again. These muscle fibers are called the lower esophageal sphincter (LES).
When this muscular ring does not close well, the contents of the stomach can be returned to
the esophagus. This is called reflux or gastroesophageal reflux. Reflux can cause
symptoms. Strong gastric acids can also damage the lining of the esophagus.
Among the risk factors for the development of reflux are:
 Consumption of alcohol (possibly)
 Hiatus hernia (a condition in which part of the stomach passes over the diaphragm,
the muscle that separates the thorax and the abdominal cavity)
 Obesity
 Pregnancy
 Scleroderma
 Smoking
 Recline less than 3 hours after eating
 Gastric acidity and gastroesophageal reflux may be caused or made worse by
pregnancy.
The symptoms may also be caused by certain medications, such as:
 Anticholinergics (for example, for dizziness)
 Bronchodilators for asthma
 Calcium channel blockers for high blood pressure
 Dopaminergic drugs for Parkinson's disease
 Progestin for abnormal menstrual bleeding or birth control
 Sedatives for insomnia or anxiety
 Tricyclic antidepressants
Signs and symptoms
The common symptoms of GERD are:
 Feel that the food gets stuck behind the sternum
 Gastric acidity or burning pain in the chest
 Nausea after eating

4. The less common symptoms are:
 Return the food (regurgitation)
 Cough or wheezing
 Difficulty swallowing
 Hiccup
 Hoarseness or changes in the voice
 Sore throat
Symptoms can get worse when you bend or lie down or after eating. The symptoms can
also be worse at night
Diagnosis
For the diagnosis of GERD, the clinical history of the patient is sufficient: presence of
heartburn, with or without regurgitation, which impairs quality of life, which appears after
eating, when lying down or stooping, which yields with alkalines and is prevented with
antisecretory drugs . Oral endoscopy is often performed in patients with GERD but is not
necessary for diagnosis. Through this exploration we can detect the presence of hiatus
hernia and complications such as esophagitis, stenosis and Barrett's esophagus, as well as
rule out other diseases. It should be practiced when there is alarm data (difficulty
swallowing, anemia, weight loss) that suggest a complication, when the patient's symptoms
are not as typical, as previously mentioned, or they do not improve with antisecretory, or
there are other Clinical-analytical data that suggest that other diseases may exist. Another
reason for performing endoscopy may be when the surgical intervention of GERD is
indicated, so that the surgeon has more information about the state of the disease.
24-hour ambulatory esophageal pH-metry is the best method to know the time that acid
gastric juice is in contact with the esophageal mucosa and to verify if the patient's
symptoms are related to episodes of GOR.
It consists of introducing a thin plastic probe through the nostrils to the lower esophagus.
The probe has sensors sensitive to changes in pH. Episodes of GER are detected by
lowering the pH in the lower esophagus. The patient, with the probe connected to a
recording device placed on a belt, is incorporated into his routine life for 24 hours. The
reading of the record will inform us of the existence of episodes of GER: number of
episodes, duration of the same, relation with the ingestion, with the posture (lying,

5. crouched or standing) and with the symptoms that it refers during this time, being able A
relationship between the episode of GOR (lowering of the pH in the esophagus) and, for
example, chest pain is evident. PHmetry will be indicated in patients with clinical diagnosis
of GERD but without response to treatment, in those who are going to undergo surgical
treatment of GER or in those who present atypical symptoms such as chest pain,
bronchospasm or dysphonia.
Treatment
Measurements:
 If you are overweight or obese, in many cases, losing weight can help.
 Elevate the head of the bed if symptoms worsen at night.
 Dine 2 to 3 hours before going to sleep.
 Avoid drugs such as acetylsalicylic acid (aspirin), ibuprofen (Advil, Motrin) or
naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve pain.
Take all your medications with plenty of water. When your provider gives you a new
medication, be sure to ask if it will make your heartburn worse.
You can use over-the-counter antacids after meals and at bedtime, although the relief may
not last long. Common side effects of antacids include diarrhea or constipation.
Other over-the-counter and prescription medications can treat GERD. They act more slowly
than antacids, but give you longer relief. The pharmacist, doctor or nurse can tell you how
to take them.
 Proton pump inhibitors (PPIs) decrease the amount of acid produced in the stomach.
 Blockers (antagonists) of H2 decrease the amount of acid released in the stomach.
Anti-reflux surgery may be an option for people whose symptoms do not go away with
changes in lifestyle and medications. Gastric acidity and other symptoms should improve
after surgery. However, you may still need to take medications for heartburn.
Likewise, there are new therapies for reflux that can be carried out by means of an
endoscope (flexible probe that is passed through the mouth to the stomach).

6. Prevention
Avoiding the factors that cause heartburn can help prevent symptoms. Obesity is linked to
GERD. Maintaining a healthy body weight can help prevent the disease.
Bibliography
 Dent J, Brun J, Fendrick AM, Fennerty MB, Janssens J, Kahrilas PJ, Lauritsen K,
Reynolds JC, Shaw M, Talley NJ. An evidence based appraisal of reflux disease
management- the Genval Workshop Report. Gut 1999; 44: S1-S16.
 Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Mon treal definition and
classification of gastroesophageal reflux disease: a global evidence-based
consensus. Am J Gastroenterol 2006; 101: 1900-1920.
 Guyatt GH, Oxman AD, Kunz R, Jaeschke R, Helfand M, Liberati A, Vist GE,
Schünemann HJ, for the GRADE working group. Rating quality of evidence and
strength of recommendations: Incorporating considerations of resources use into
grading recommendations. BMJ 2008; 336: 1170-1173.