Gastro esophageal reflux disease (GERD) is a chronic digestive disease. GERD occurs when stomach acid or, occasionally, stomach content, flows back into your food pipe (esophagus). The backwash (reflux) irritates the lining of your esophagus and causes GERD. This is a very common condition observed please comment thank you

1. GERD | Gastro
esophageal
reflux disease
a brief medical study
PRESENTED BY
MARTIN SHAJI
PHARM D

2. Summary
Introduction | definition
Causes
Pathogenesis
When to see a doctor
Risk factors
Symptoms
Diagnosis
Treatment
Drugs
• Surgical options
• Prevention
• Complication
• Life style changes
• Images
• References

3. Introduction |Definition
• Gastro esophageal reflux disease (GERD) is a chronic digestive
disease. GERD occurs when stomach acid or, occasionally,
stomach content, flows back into your food pipe (esophagus).
The backwash (reflux) irritates the lining of your esophagus and
causes GERD.
• Both acid reflux and heartburn are common digestive conditions
that many people experience from time to time. When these
signs and symptoms occur at least twice each week or interfere
with your daily life, or when your doctor can see damage to your
esophagus, you may be diagnosed with GERD.

4. • Most people can manage the discomfort of GERD with
lifestyle changes and over-the-counter medications. But
some people with GERD may need stronger medications, or
even surgery, to reduce symptoms.

5. Symptoms
• A burning sensation in your chest (heartburn), sometimes spreading to
your throat, along with a sour taste in your mouth
• Chest pain
• Difficulty swallowing (dysphagia)
• Dry cough
• Hoarseness or sore throat
• Regurgitation of food or sour liquid (acid reflux)
• Sensation of a lump in your throat

6. When to see a doctor
• Seek immediate medical attention if you experience chest pain,
especially if you have other signs and symptoms, such as
shortness of breath or jaw or arm pain. These may be signs and
symptoms of a heart attack.
• Make an appointment with your doctor if you experience severe
or frequent GERD symptoms. If you take over-the-counter
medications for heartburn more than twice a week, see your
doctor.

7. Causes
• GERD is caused by frequent acid reflux — the backup of stomach acid or
bile into the esophagus.
• When you swallow, the lower esophageal sphincter — a circular band of
muscle around the bottom part of your esophagus — relaxes to allow
food and liquid to flow down into your stomach. Then it closes again.
• However, if this valve relaxes abnormally or weakens, stomach acid can
flow back up into your esophagus, causing frequent heartburn.
Sometimes this can disrupt your daily life.

8. • This constant backwash of acid can irritate the lining of your
esophagus, causing it to become inflamed (esophagitis). Over
time, the inflammation can wear away the esophageal lining,
causing complications such as bleeding, esophageal narrowing or
Barrett's esophagus (a precancerous condition).

9. Pathogenesis
• The pathogenesis of gastro esophageal reflux disease (GERD) is
complex and involves changes in reflux exposure, epithelial
resistance, and visceral sensitivity. The gastric refluxate is a noxious
material that injures the esophagus and elicits symptoms.
Esophageal exposure to gastric refluxate is the primary determinant
of disease severity. This exposure arises via compromise of the anti-
reflux barrier and reduced ability of the esophagus to clear and
buffer the refluxate, leading to reflux disease. However,
complications and symptoms also occur in the context of normal
reflux burden, when there is either poor epithelial resistance or
increased visceral sensitivity. Reflux therefore develops via
alterations in the balance of aggressive and defensive forces.

10. Pathophysiology
• Schematically, the esophagus, lower esophageal sphincter (LES), and
stomach can be envisioned as a simple plumbing circuit as described by
Stein and coworkers. The esophagus functions as an antegrade pump,
the LES as a valve, and the stomach as a reservoir. The abnormalities
that contribute to GERD can stem from any component of the system.
Poor esophageal motility decreases clearance of acidic material. A
dysfunctional LES allows reflux of large amounts of gastric juice.
Delayed gastric emptying can increase the volume and pressure in the
reservoir until the valve mechanism is defeated, leading to GERD. From
a medical or surgical standpoint, it is extremely important to identify
which of these components is defective so that an effective therapy can
be applied.

11. Treatment
• Antacids. Doctors often first recommend antacids to relieve
heartburn and other mild GER and GERD symptoms.
• H2 blockers. H2 blockers decrease acid production. They provide
short-term or on-demand relief for many people with GER and GERD
symptoms
• cimetidine
• famotidine
• nizatidine
• ranitidine

12. • Proton pump inhibitors (PPIs). PPIs lower the amount of acid your
stomach makes. PPIs are better at treating GERD symptoms than H2
blockers. They can heal the esophageal lining in most people with GERD
• Several types of PPIs are available by a doctor’s prescription, including
• esomeprazole
• lansoprazole
• omeprazole
• pantoprazole
• rabeprazole
Prokinetics help your stomach empty faster. Prescription prokinetics
include
bethanechol
metoclopramide

13. Surgical Options
• Fundoplication is the most common surgery for GERD. In most
cases, it leads to long-term reflux control.
• A surgeon performs fundoplication using a laparoscope, a thin tube
with a tiny video camera. During the operation, a surgeon sews the
top of your stomach around your esophagus to add pressure to the
lower end of your esophagus and reduce reflux. The surgeon
performs the operation at a hospital. You receive general
anesthesia and can leave the hospital in 1 to 3 days. Most people
return to their usual daily activities in 2 to 3 weeks.

14. Risk Factors
• Conditions that can increase your risk of GERD include:
• Obesity
• Bulging of top of stomach up into the diaphragm (hiatal hernia)
• Pregnancy
• Smoking
• Dry mouth

15. • Asthma
• Diabetes
• Delayed stomach emptying
• Connective tissue disorders, such as scleroderma

16. Complications
• Over time, chronic inflammation in your esophagus can lead to
complications, including:
• Narrowing of the esophagus (esophageal stricture). Damage to cells in
the lower esophagus from acid exposure leads to formation of scar
tissue. The scar tissue narrows the food pathway, causing difficulty
swallowing.
• An open sore in the esophagus (esophageal ulcer). #Stomach acid can
severely

17. • #erode tissues in the esophagus, causing an #open #sore to
#form. The esophageal #ulcer may #bleed, #cause #pain and
make #swallowing #difficult.
• #Precancerous changes to the esophagus (Barrett's
esophagus). In #Barrett's esophagus, the #tissue #lining the
lower #esophagus changes. These #changes are #associated
with an increased risk of esophageal cancer. The #risk of
cancer is low, but your #doctor will likely #recommend
#regular #endoscopy #exams to #look for #early #warning
#signs of #esophageal #cancer.

18. Lifestyle changes
• Making lifestyle changes can reduce your GER and GERD symptoms.
You should
• lose weight, if needed.
• wear loose-fitting clothing around your abdomen. Tight clothing can
squeeze your stomach area and push acid up into your esophagus.
• stay upright for 3 hours after meals. Avoid reclining and slouching
when sitting.
• sleep on a slight angle. Raise the head of your bed 6 to 8 inches by
safely putting blocks under the bedposts. Just using extra pillows will
not help.
• quit smoking NIH external link and avoid secondhand smoke.

19. Reference
• Understanding Heartburn and Reflux Disease. American
Gastroenterological Association
• Textbook of cardiac pharmacology
• My teachers and mentors

20. Thank
you ….
MARTIN SHAJI
martinsuja369@gmail.com