Gastroesophageal reflux disease (GERD) is caused by gastric acid irritating the esophagus. It is often due to transient lower esophageal sphincter relaxations that allow acid to flow back into the esophagus. Risk factors include smoking, caffeine, alcohol, obesity, pregnancy, hiatal hernia, and medications. Symptoms include heartburn, regurgitation, dysphagia, and atypical symptoms like chest pressure or cough. Diagnosis involves testing like endoscopy and pH monitoring if symptoms persist after trial of proton pump inhibitor treatment or if high risk complications are present. Treatment focuses on lifestyle changes and acid suppression with proton pump inhibitors or H2 blockers.

1. Gastroesophageal flux
DiseaseRessoph. causing irritation to the masae
Etiology:-
->
Gastroesophageal Junction Dysfunction - ↑ Frequency of
transient
LES Relaxations
"
TLESR,"(Caffeine And Nitroglycerin)
LanatomiC Abnormalities of
of Junction Chiatal hernia And tumors)
- >
Impaired Esoph. Acid Clearance -
Normally, Acid Reflex is neutralized by
salivary bi-carbonate and back to
Lstomach via Esoph.
O
peristalsis
↓
pearance,canbedisrupted
by reduced Salination (smokings
andare
S
Risk factors-
is
*
smoking, caffeine And
Alcohol
A
1 - 6 LES tone 1- 6 LES tone
x
stress -- A
gastric Acid 2- ↑ gastric Acid
x
obesity ↑ Abdominal Pressures
* Pregnancy ↑ Abdominal Pressure
-I
-
Lo LES fone 4 Progesterone And 4 Estrogen
*Angle of
his 6: normal 50-60
X
Sclero-derma
x
sliding hiatal hernia
*
Asthma B2 Agonists
Clinical features:
*
Typical symptoms - Retrosternal Pain (heartburn)
↓
Regurgitation
- _
° Dysphagia
L water brash, excessive salivations
*
Atypical symptoms
-
Pressure sensation in the chest
↓
Belching
-
DYSPCPSia "Discomfort"
L Nause a
-
↳
Aspiration Pheumonia
*
Extra-Esoph. symptoms - chronic non-productive cough
I Hoarseness Husky voice"
- Dental Erosion

2. Aggravating factors: -
~ Ling Down shortly After meals
* certain foods/beverages
Red flags
8 Anemia And/or GS Bleeding"
hematemesis, hematochezia
"
0 weight loss
o vomiting *
Male
·Presence of 71 Risk for Barrett esoph.
*rees, soy
~ obe se
* SYMP1oms>5Y
*
European Decent
Diagnosis:-
- There is no gold standard test
for the Dx of
GERD.
- If Patient with chest pain -> ECG + Cardiac Enzyme "troPonin" ->
Normal
- Patient with suspecte GERD Without
Red flags or high Risk of
Barrett Esoph. Start with once-Daily
PPI
for 8
*
If
relief
symptoms of
GERD -
can stop PPI
* If Persist
symptoms or Recur After stop PPI
or Red flags or High Risk for Barrett
ESOPL. ->
E6D
A
esoau. Monitoring
*
If Erosive will see by
↳ measure so. PH over
24-48 h using telemetry
capsule catheter
- PH ->
Abnormal "Nor-crosise Reflux Disease"
I
X
treat by PPI
for 8 W
- With Normal EGD And PH treat
by Low Dose PPI
or H2 Antagonists
-I

3. ↑
reatment :-
*
Initial with lifestyle changes And Acid suppression therapy ppy, Hz Antagonist.
*
Surgical therapy"
is not Routinely indicated"(fundoplication() 18: Dor fundo.
!27 Toupet
fundo.
360 complete fund.
"Nissen fundoplication"
complication..
B arrett Esophages "Intestinal metaplasia of
the ESOPL. mucosa
IDA -
mucosal erosion and ulceration - Chronic Bleeding-
Anemia
Esophageal stricture
=
SoPhageal Ring "Schatzki Rings"
Aspiration pneumonia
Reflux
laryngitis Hoarsenesss)
*
St
-