1. The document discusses Gastroesophageal Reflux Disease (GERD) and the relationship between GERD and stress. It covers the epidemiology, etiology, pathophysiology, classification, risk factors, signs and symptoms, complications, diagnosis and treatment of GERD. 2. Stress can exacerbate GERD through various physiological changes like decreasing LES tone, delayed gastric emptying, and increased cortisol levels. Stress coupled with exhaustion can increase acid reflux symptoms. 3. While many factors can cause GERD, stress is a major contributing factor due to modern lifestyles. Managing stress is important for treating GERD and preventing its complications.

1. SUBMITTED BY
BE BE THAHERA
REG NO:127NIROOO2
IV B. PHARMACY
VIJAYA INSTITUTE OF PHARMACEUTICAL SCIENCES FOR
WOMEN
A Seminar on
Gastroesophageal Reflux Disease
&
Stress
Under the guidance of
D. Santhi Krupa, M.Pharm.,
Assistant Professor,
Dept of Pharmacology
&

2. CONTENTS
● INTRODUCTION
● EPIDEMOLOGY
● ETIOLOGY
● PATHOPHYSIOLOGY
● CLASSIFICATION OF GERD
● RISK FACTORS
● SIGNS & SYMPTOMS
● COMPLICATIONS OF GERD
● DIAGNOSIS
● TREATMENT
● RELATIONSHIP BETWEEN GERD & STRESS
● CONCLUSION
● REFERENCES

3. INTRODUCTION
● Gastroesophageal Reflux Disease (GERD) is a common chronic
disorder in which the liquid content of the stomach regurgitates into
the esophagus and causes esophagitis.
● Stress is a physical, mental, or emotional factor that causes bodily or
mental tension.

4. EPIDEMOLOGY
• In the India, the prevalence range for GERD is 8% to 20%
of the population.
ETIOLOGY
• Decrease tone of the Lower Esophageal Spincture
• Decreased Parasympathetic activity and increased
Sympathetic activity
• Release of Cortisol glucocorticoid from adrenal gland
during stress condition
• Increased levels of estrogen and progesterone in Women

5. PATHOPHYSIOLOGY
GERD Pathophysiology is based on the following
1. Esophageal defense mechanisms
2. Dysfunction of the lower esophageal sphincter
3. Delayed gastric emptying
4. Hiatal hernia

6. 1.Esophageal defense mechanisms 2.Dysfunction of the lower
esophageal sphincter
3.Delayed gastric emptying 4.Hiatal hernia

7. CLASSIFICATION OF GERD
Gastroesophageal reflux disease is broadly classified
into two groups on the basis of endoscopy findings:
1. Erosive esophagitis and Barrett’s esophagus
2. Negative reflux disease (or) Nonerosive reflux disease
(NERD)

8. RISK FACTORS
1. Stress
2. Food allergies and intolerances.
3. Age
4. Pregnancy
5. Obesity
6. Medications
7. Alcohol and tobacco
8. Genetics
9. Zollinger-Ellison syndrome
10. Hypercalcemia

9. SIGNS & SYMPTOMS
The major symptoms seen in GERD are
1. Heartburn
2. Regurgitation
3. Chronic cough
4. Dysphagia

10. COMPLICATIONS OF GERD
Over time, chronic inflammation in esophagus can lead to
complications, including
 Ulcers
 Strictures
 Barrett's esophagus
 Cough and asthma
 Inflammation of the throat and larynx
 Inflammation and infection of the lungs
 Fluid in the sinuses and middle ears

11. DIAGNOSIS
GERD can be diagnosed primarily based on the
symptoms, followed by the below mentioned methods
•Gastric Emptying Studies
•PH
Monitoring Test
•Endoscopy

12. TREATMENT
Treatment for GastroEsophageal Reflux disease is aimed at:
a. Reducing backflow, or reflux, of stomach acid and juices into the
esophagus.
b. Preventing damage to the lining of the esophagus, or helping to heal
the lining if damage has occurred.
c. Keeping GERD from coming back.
d. Preventing health problems that can occur because of GERD.

13. TREATMENT
It involve the use of drugs and surgical methods
Medication:
A number of different medications can be used to
treat GERD. This include:
● Over-the-counter medications
● Proton-pump inhibitors (PPIs)
● Histamine-receptor antagonists (H2RA)

14. MECHANISM OF ACTION Of DRUGS
Proton pump inhibitors:
They act by irreversibly blocking the H+
/K+
ATPase, the gastric
proton pump) of the gastric parietal cells ,making it an ideal target for
inhibiting acid secretion.
Eg: Omeprazole, Lansoprazole, Radeprazole
H2-receptor antagonists:
The H2 antagonists are competitive antagonists of histamine at the
parietal cell H2 receptor.
Eg: Rantidine, Famotidine

15. SURGICAL METHODS
Several Endoscopic and Laproscopic methods are used to treat
GERD .
Especially Laparoscopic insertion of a magnetic bead band
(LINX) is the safe and effective method

16. RELATIONSHIP BETWEEN GERD & STRESS
● Medically stress is a physical, mental, or emotional factor that causes
bodily or mental tension.
● Reflux is a normal physiologic occurrence and is produced most often
by transient relaxation of the LES.
● In patients with GERD, the transient relaxations of LES occurs more,
than normal.
● Under normal conditions, endogenous defense mechanisms either
limit the amount of noxious material entering into the esophagus or
clear it rapidly, to minimize the esophageal mucosal irritation.

17.  Currently, many scientists
believe that when we are
stressed, we will become more
sensitive to smaller amounts of
acid in the esophagus.
 Stress, coupled(fastens) with
exhaustion, may present even
more body changes that lead to
increased acid reflux.
 Due to which person who
suffers from acid reflux knows
that stress will make them un-
comfortable.

18. ● Stress input from Hypothalamus(pvn),
● visceral & somatic affrents Amygdala &
Periaqueductal grey
Pitutatory & Pontomedullary nuclei
Neuro endocrine Effects Autonomic output changes
STRESS PATHWAY

19. MECHANISM FOR THE OCCURRENCE OF
STRESS BASED GERD

20. CHANGES DURING STRESS INDUCED GERD
● Here activation of some sympathetic nerves & decreased
activity of parasympathetic activity occurs, which play a role in
physiologic responses like
1. Increasing the permeability of the gut
2. Delayed gastric emptying
3. During stress blood flow is diverted from the digestive organs
to the heart and muscles
4. Digestive enzymes is slowed, intestinal contractions and
absorption of nutrients is ceased
5. Altering the quantity of mucin.
6. Altering immune function in the reactivation of inflammatory
mucosal changes in GERD.

21. CONCLUSION
● Under normal situations, endogenous defense mechanisms
either limit the amount of noxious material or gastric acid
that is introduced into the esophagus or rapidly clear the
material from the esophagus so that symptoms of
esophageal mucosal irritation are minimized.
● In Stress related GERD, Cortisol hormone released into
blood , induces changes in GIT physiology, relaxes LES and
causes regurgitation.
● In case of women, the increased levels of estrogen &
progesterone will cause relaxation of the LES & increase the
incidence of GERD .

22. CONCLUSION
Although, there are many risk factors which
causes occurrence and recurrence of GERD,
stress is the major factor which occurs with
lifestyle modification in the present scenario,
and leads to further complications. So, Stress
related GERD should be carefully treated
before the condition become worse in
patients.

23. REFERENCES
● Anvari M, Allen C, Marshall J, Armstrong D, Goeree R, Ungar W, et al. A
randomized controlled trial of laparoscopic nissen fundoplication versus
proton pump inhibitors for treatment of patients with chronic
gastroesophageal reflux disease: One-year follow-up. Surg Innov.,. 2006;
13(4):238-49.David y. graham and Yoshio yamaoka .h. pylori and caga:
relationships with gastric cancer, duodenal ulcer, and reflux esophagitis and its
complications., 1998; 3: 145-151.
● DeVault KR, Castell DO. "Updated guidelines for the diagnosis and treatment of
gastroesophageal reflux disease. The Practice Parameters Committee of the
American College of Gastroenterology". Am J Gastroenterol.,1999; 94 (6): 1434–
42.
● El-Serag HB. Time trends of gastroesophageal reflux disease: a systematic
review. Clin GastroenterolHepatol,. 2007; 5(1):17-26.
● Fass R, Sifrim D. Management of heartburn not responding to proton pump
inhibitors. Gut., 2009; 58(2): 295-309.
● Fass R. Proton pump inhibitor failure--what are the therapeutic options? Am J
Gastroenterol., 2009; 2:S33-38.
● Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V.
Management strategy for patients with gastroesophageal reflux disease: a
comparison between empirical treatment with esomeprazole and endoscopy-
oriented treatment. Am J Gastroenterol., 2008; 103(2): 267-75. DD

24. ● Heidelbaugh JJ, Goldberg KL, Inadomi JM. Overutilization of proton
pump inhibitors: a review of cost-effectiveness and risk. Am J
Gastroenterol., 2009; 2: S27-32.
● Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG.
Gastroesophageal reflux disease and obesity. Pathophysiology and
implications for treatment. J Gastrointest Surg., 2007; 11(3): 286-90.
● Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM,
Johnson SP, Allen J, Brill J. "American Gastroenterological Association
Medical Position Statement on the management of gastroesophageal
reflux disease". Gastroenterology., 2008; 135 (4): 1383–1391.
● R. Jones and J. P. Galmiche. Review: What do we mean by GERD? –
definition and diagnosis. Alimentary and pharmacology therapeutics.,
2000; 67(2): 106-111
● Kahrilas PJ, Farré R, Bouvy ND, Masclee AA, Conchillo JM .The effect of
endoscopic fundoplication and proton pump inhibitors on baseline
impedance and heartburn severity in GERD patients. Neurogastroenterol
Motil., 2015; 27(2):220-8.
REFERENCES

25. ● Kahrilas PJ, Farré R, Bouvy ND, Masclee AA, Conchillo JM .The
effect of endoscopic fundoplication and proton pump inhibitors on
baseline impedance and heartburn severity in GERD patients.
Neurogastroenterol Motil., 2015; 27(2):220-8.
● Tytgat GN. Review article: treatment of mild and severe cases of
GERD. Aliment Pharmacol Therapeutics., 2002; 4:73-78.
● Ujjal poddar.Diagnosis and managent of GERD in india. Indian
pediatrics., 2013; 50:119-127.
● Zajac P, Holbrook A, Super ME, Vogt M. "An overview: Current
clinical guidelines for the evaluation, diagnosis, treatment, and
management of dyspepsia". Osteopathic Family Physician., 2013; 5
(2): 79–85.
● http://www.aboutgerd.org/site/what-is-gerd/intro
REFERENCES