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GASTROESOPHAGEAL REFLUX DISEASE
Dr Shuaib Ansari
Associate Professor
Medical Unit III
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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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The normal antireflux mechanisms consist of
LES crural diaphragm anatomical location of the gastroesophageal junction
below the diaphragmatic hiatus.
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ANTI-REFLUX MECHANISM
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Pathophysiology:Lower Esophageal
Sphincter– changes in resting pressure (incompetent LES), abnormal location (hiatal hernia)
Excess acid productionDelayed gastric
emptyingDecreased mucosal
resistance to acid injury
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CREST syndrome : Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasias.
FACTORS ASSOCIATED WITH THE DEVELOPMENT OF GERD
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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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COMPLICATIONS
Esophagitis Esophageal ulcer Barrett's oesophagus Aspiration pneumonia Iron deficiency Anaemia Esophageal stricture Adenocarcinoma of esophagus
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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 hernia4. 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 12
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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).
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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B. Medical treatment: 1. Liquid antacid: 10-15 ml TID2. H2 receptor antagonists like ranitidine 150mg
orally BD for 6-8 weeks3. 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 transfusion16
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SURGICAL TREATMENT.
Surgical resection of stricture Nissen Fundoplication
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I’m worriedand concerned
GI symptoms bother me!
My whole life is affected
Heartburn disturbs my
sleep
I cannot eat and drink whatever
I like
I cannot bendover or exercise
ZOPENT
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