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Gerd Gerd Gerd: Dr. Rocky Danilo Willis, M.D., AMT

This document discusses a case of GERD (gastroesophageal reflux disease). It provides details of the patient's history, symptoms, physical exam findings, and leads to a diagnosis of GERD. It then discusses the mechanisms, causes, clinical features, diagnostic approaches, and treatment options for GERD, including lifestyle changes, medications like PPIs, and anti-reflux surgery if needed. The goal of treatment is relief of symptoms, healing of erosions, and prevention of complications.

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Rocky Willis
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183 views31 pages

Gerd Gerd Gerd: Dr. Rocky Danilo Willis, M.D., AMT

This document discusses a case of GERD (gastroesophageal reflux disease). It provides details of the patient's history, symptoms, physical exam findings, and leads to a diagnosis of GERD. It then discusses the mechanisms, causes, clinical features, diagnostic approaches, and treatment options for GERD, including lifestyle changes, medications like PPIs, and anti-reflux surgery if needed. The goal of treatment is relief of symptoms, healing of erosions, and prevention of complications.

Uploaded by

Rocky Willis
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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GERD GERD GERD

Dr. Rocky Danilo Willis, M.D.,


AMT
CASE 1
• J.D.
• 28 years old
• Male
• Roman Catholic
Chief complaint

CHEST PAIN
History of present illness
1 week ptc ------ ( + ) chest pain, 3/10 in pain
scale ,non radiating w/ feeling
of burning like sensation
especially when lying down,and
relieved by sitting down
position
( + ) dysphagia
( - ) nausea/vomiting
( - ) dizziness
( - ) dob
• Few hours ptc – still w/ s/s now with feeling of
nausea hence consult to opd
Past Medical history
• Unremarkable

Family History
- unremarkable
Personal and Social History
• ( + )10 pack/year smoker
( + ) occasional alcoholic beverage drinker
( + ) heavy coffee drinker consuming 3-4 cups
( - ) allergy to food and drugs
Review of Systems
• General: no fever, no chills, (-) body weakness,
no body malaise
• Neuro: no headache, no dizziness
• Cardivascular: ( + )chest pain, no palpitations,
no orthopnea
• Respiratory: no cough, no colds, no dob, no
shortness of breath
Review of systems
• Digestive: ( + )nausea, no vomiting, no
retching, no epigastric pain
• Genitourinary: no polyuria, no dysuria, no
increase in frequency
• Hematology: no bleeding manifestations
Physical examination
• General Survey
• conscious, coherent, ambulatory
• Vital Signs:
• BP: 120/80mmHg HR: 76 bpm
• RR: 20 cpm T: 36.6°C
• Wt: 110 kgs
• Head/EENT:
• pink palpebral conjunctivae, anicteric sclerae, no
nasoaural discharge, non hyperemic posterior
pharyngeal wall
• Neck
• supple neck, no cervical lymph adenopathies
• no neck vein engorgement
• Chest/Lungs:
• symmetrical chest expansion, no retractions, clear
breath sounds
• Heart:
• adynamic precordium, normal rate, regular
rhythm, apex beat at 5th LICS MCL, no murmur
• Abdomen:
• Globular abdomen, hypoactive bowel sounds,
distended, non tender, no hepatosplenomegaly
• Extremities:no cyanosis, full and equal pulse
Diagnosis

GASTROESOPHAGEAL REFLUX DISEASE


GERD
- Most prevalent GI disorders
- 15 % individuals have heartburn 1x/week
- 7 % symptoms daily
- Caused by backflow of gastric acid and other
gastric contents into esophagus due to
incompetent barriers at the GE junction
ANTI REFLUX MECHANISMS
• LES
• Crural diaphragm
• Anatomic location of GE junction below
diaphragmatic hiatus
REFLUX
- occurs when gradient pressure between LES and
stomach is lost
- Due to sustained or transient decrease in LES
stone
Secondary causes of LES incompetence
- Scleroderma-like
disease,myopathy,pregnacy,smoking,anticholine
rgic drugs,smooth muscle relaxants,esophagitis
surgical damage to LES
Apart of incompetent barriers, reflux are most
likely due to
1. Gastric volume is increased – after meals,in
pyloric obstruction, gastric stasis, during hyperacid
secretion states
2. Gastic contents are near to GE junction –
recumbency, lying down, hiatal hernia
3. Inc. Gastric pressure - obesity, pregnacy,ascites,
tight clothes
• Reflux esophagitis- complication of reflux
• Peptic stricture – results from fibrosis causing
luminal obstruction
- occur in 10 % patient untreated gerd
CLINICAL FEATURES
• Heartburn and regurgitation of sour material
-characterized symptoms of GERD
-induced by contact of refluxed material with
sensitized or ulcereated esophageal mucosa

- Angina like symptoms or atypical chest pain


occurs in some patient
EXTRAESOPHAGEAL MANIFESTATIONS
• due to reflux of gastric contents to
pharynx,larynx,nose and mouth
• Can cause – chronic cough, laryngitis,
pharyngitis and mouth, moarning hoarseness
DIAGNOSIS
• Can be made by history alone
• Therapeutic trial of PPI x 1 week –support for
diagnosis
DIAGNOSTIC APPROACH
1. Documentation of mucosal injury
2. Documentation and quanification of reflux
3. Definition of pathophysiology
Documentation of mucosal injury
• barium swallow- reveal ulcer
• esophagoscopy- reveals erosions,ulcers, peptic
strictures,barrets metaplasia w/ or w/o ulcer, adenoCA
- not diagnostic of gerd
- Mucosal biopsy- 5 cm above LES
- Bernsteins test- infusions of solutions of 0.1 N hcl or
NSS into esophagus
Documentation and Quantification of Reflux
• 24-48 hr esophageal pH monitoring
- achored to esopahgeal mucosa via endoscope
- evaluation of acid reflux
Impedance test – documenation of non acid test
Documentation of Pathophysiology
• Indicated for management decisions of
antireflux surgery
• Esophageal motilility – useful for quantitative
information of competence of LES or esophageal
motor function
TREATMENT
GOALS
1. Symptomatic relief
2. Heal erosive esophagitis
3. Prevent complications
MILD CASES
- weight reduction
- sleeping w/ head elevated 4-6 cms
- eliminate factors causes of increase abdominal
pressure
- no smoke
- avoid fatty foods,coffee,chocolate, alcohol
- AVOID DRINK LOTS OF FLUIDS W/ MEALS
• DRUGS ( h2 receptor blocker )
- cimetidine 300 mg qid
- ranitidine 150 mg bid
- famotidine 20 mg bid
- nizatidine 150 mg bid
Proton Pump Inhibitors
• More effective
• Prevent recurrence
- omeprazole 20 mg od
- lansoprazole 30 mg od
- esomeprazole 40 mg od
- rabeprazole 20 md
> x 8 weeks can heal erosive esophagitis in 99
% patients
• ANTI REFLUX SURGERY – gastric fundus
wrapped around esophagus ( fundoplication)
so it can create anti reflux barrier
THANK YOU

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