Scribd
Upload
80 views

GERD

Gastro-Esophageal Reflux Disease (GERD) is the most common upper gastrointestinal disorder, affecting 45% of the population. It is caused by abnormal reflux of gastric contents into the esophagus, damaging the esophageal lining. Symptoms include heartburn, regurgitation, and dysphagia. Complications can include esophagitis, strictures, Barrett's esophagus, and adenocarcinoma. Treatment involves lifestyle modifications, antacids, H2 blockers, proton pump inhibitors, and sometimes Nissen fundoplication surgery for severe cases.

Uploaded by

ايمن منصر
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
80 views

GERD

Gastro-Esophageal Reflux Disease (GERD) is the most common upper gastrointestinal disorder, affecting 45% of the population. It is caused by abnormal reflux of gastric contents into the esophagus, damaging the esophageal lining. Symptoms include heartburn, regurgitation, and dysphagia. Complications can include esophagitis, strictures, Barrett's esophagus, and adenocarcinoma. Treatment involves lifestyle modifications, antacids, H2 blockers, proton pump inhibitors, and sometimes Nissen fundoplication surgery for severe cases.

Uploaded by

ايمن منصر
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 12

Gastro-Esophageal Reflux Disease

1
Gastro-Esophageal Reflux Disease

2
Gastro-Esophageal Reflux Disease

Gastro-Esophageal Reflux Disease


( GERD )
 Definition : Exposure of the lower esophageal mucosa to pH less than 4
, more than 4% of the 24 hours period.

➢ Normally , about 50 GER episode can occur every 24 hours ,


but all are of very short duration.

 Incidence :

▪ GERD is the commonest upper GIT disorder.


▪ It affects 45% of population .
▪ GERD & peptic esophagitis is the commonest upper GIT endoscopic
finding (25%).
 Physiology :
▪ Normally , there is a physiological sphincter at the cardio-esophageal
junction maintaining a high pressure zone of 15-25 cm H2O .

▪ physiological sphincter at the cardio-esophageal junction is


attributed to:

1- The lower 3cm of the esophagus is intra-abdominal which create


a competent lower esophageal sphincter .

2- The sphincteric function of circular muscle fibers of the lower


part of esophagus.

3- The valve like action of the acute cardio-esophageal angle

( angle of His ).
3
Gastro-Esophageal Reflux Disease

4- The mucosal rosette at the cardio-esophageal junction.


5- Action of the right crus of the diaphragm which close the lower
end of esophagus during deep inspiration or sudden increase of
intra-abdominal pressure eg. Cough…etc .
5- A band of circular muscle which commences in the fundus of the
stomach and passes around the cardio-esophageal junction.

4
Gastro-Esophageal Reflux Disease

5
Gastro-Esophageal Reflux Disease

▪ Clearance of refluxate from lower end of esophagus by 2


mechanisms :
1- Normal petristalsis of lower esophagus during swallowing .
2- Chemical neutralization of the swallowed alkaline saliva .
 Aetiology :
I) Dysfunction of lower esophageal sphincter due to :
1-Short intra-abdominal part of the esophagus as in sliding hiatus
hernia .
2- Weakness of lower esophageal sphincter.
3- Increase in transient relaxation of lower esophageal sphincter.
II) Gastric distension :
▪ Usually functional due to food which slow gastric emptying like fat
, coffee & chocolate .
 Complications :
1- Reflux esophagitis with variable degree of erosions & ulceration .
2- Upper GIT bleeding which is mild → iron deficiency anemia .
3- Strictures & shortening of esophagus (early due to spasm & later on
due to fibrosis ) .
4- Sliding hiatus hernia .
5- Respiratory complications .
6- Barrett’s esophagus :
▪ It is a columnar metaplasia of the lower esophagus in response
to chronic acid irritation .
▪ The metaplasia is usually intestinal or rarely gastric type .

6
Gastro-Esophageal Reflux Disease

▪ Intestinal type is precancerous which may turn into


adenocarcinoma of the esophagus .
▪ Regular endoscopic follow up & multiple biopsies are
essential .
▪ Endoscopic mucosal resection using photodynamic
therapy or argon beam coagulation or radiofrequency
ablation can be used in marked dysplasia before development of
carcinoma .
 Clinical picture :
I) High risk patient : Obesity , fast foods , caffeine, alcohol , smoking
and certain drugs as antihistaminics & calcium channels blockers .
II) Typical symptoms :
1- The classical triade of GERD is heat burn is the (commonest
symptom ) , regurgitation & dysphagia .
2- Water brush (Regurgitation of watery acidic fluid
from the stomach to the throat ) .
3- Odynophagia ( painful swallowing due to esophagitis , pharyngitis
& laryngitis ) .
➢ All previous symptoms are aggravated by large heavy meal ,
lying flat or bending forewards & more by night and relieved by
sitting.

7
Gastro-Esophageal Reflux Disease

III) Atypical symptoms :


1- Chest pain simulating angina .
2- Respiratory manifestations simulating bronchial asthma .
3- Laryngeal manifestations as cough , choking & changes of voice .
4- Anemia , melaena or haematemesis in sever esophageal
ulcerations .
 Investigations :
1- Upper GIT endoscopy : ( most important )
▪ It shows the grade of esophagitis , presence of hiatus hernia and
biopsy to exclude Barret’s esophagus or malignancy .

8
Gastro-Esophageal Reflux Disease

▪ Endoscopic grading of reflux esophagitis :


➢ Grade I : Hyperaemic mucosa .
➢ Grade II : Superficial ulceration of mucosa only .
➢ Grade III : Deep ulceration.
➢ Grade IV : Stricture or Barrett’s esophagus .
2- Barium meal in Trendenlenburg’s position show reflux of contrast
medium into the esophagus .

3- Esophageal manometry : to detect weakness of lower esophageal


sphincter .
4- PH study :
▪ 24 hours pH monitoring is most reliable test to diagnose GERD.
▪ A small probe is passed through the nose to the lower
esophagus and pH is recorded and analysed for 24 hours.
▪ In GERD , there is low pH in the esophagus for long period .
9
Gastro-Esophageal Reflux Disease

▪ The patient is asked to record when he gets the symptoms .If


symptoms coincides with the low pH record , this show that these
symptoms are due to reflux .

 Treatment :
I) Conservative :
▪ Indications : the main line of treatment in 90% of cases .
▪ Methods :
➢ Weight reduction markedly improve the symptoms .
➢ Antacids , H2 receptors blockers & proton pump inhibitor ( main
treatment )
➢ Avoid smocking , alcohol , spicy food , coffee , chocolate , fatty &
large meal .
➢ Avoid recumbence after meals for at least 2 hours .
➢ Elevation of the head and bed 15 degree to reduce reflux .
10
Gastro-Esophageal Reflux Disease

II) Surgical :
▪ Indications : failure of medical treatment or complications .
▪ Method : Laparoscopic Nissen’s fundoplication .
➢ Complete wrapping of the fundus of the stomach around the lower
esophagus to creat a high pressure zone .

11
Gastro-Esophageal Reflux Disease

12

You might also like