Gastroesophageal Reflux Disease (GERD) 2017 PDF

Gastroesophageal reflux disease (GERD) Dr. Patricia A. Romero MD, MSc Dr. Simón Q. Rodríguez Lara MD, PHD WE MAKE DOCTORS Objectives A. Recall the definition of Gastroesophageal reflux disease (GERD) B. Learn the classification of Los Angeles for er...

Gastroesophageal reflux disease (GERD) Dr. Patricia A. Romero MD, MSc Dr. Simón Q. Rodríguez Lara MD, PHD WE MAKE DOCTORS Objectives A. Recall the definition of Gastroesophageal reflux disease (GERD) B. Learn the classification of Los Angeles for erosive esophagitis C. Understand the pathophysiology of GERD D. Acknowledge the structure, pharmacokinetic & pharmacodynamic properties of medications used in the treatment of GERD: I. Antacids II. H2R antagonist III. PPIs IV. Prostaglandin analogs V. Cholinemimetics VI. Dopamine antagonist 2  Definition Gastroesophageal reflux disease (GERD) is a sensorimotor disorder associated with impairment of the normal antireflux mechanisms (lower esophageal sphincter function, phrenicoesophageal ligament), with changes in normal physiology (impaired esophageal peristalsis, increased intragastric pressure, increased abdominothoracic pressure gradient), or very rarely, excess gastric Gastroesophageal reflux is acid secretion (Zollinger-Ellison syndrome). physiological, however, when it causes macroscopic damage to the esophagus or causes symptoms → Disease (GERD) Hunt R, Armstrong D, Katelaris P, Afihene M, Bane A, Bhatia S, et al. World gastroenterology organisation global guidelines: GERD global perspective on gastroesophageal reflux disease. Journal of clinical gastroenterology. 2017;51(6):467-78. 3  Epidemiology GERD is common and its prevalence varies in different parts of the world. Increasing prevalence in many developing countries. The USA is of 18.1-27.8%, South America 16.5- 23%, Europe 8.8-25.9%, Middle East 8.7-21.2%, and East Asia lower than 10%. Incidence The USA: 5.4 per 1000 person-year. Europe: 4.5 per 1000 person-year. Hunt R, Armstrong D, Katelaris P, Afihene M, Bane A, Bhatia S, et al. World gastroenterology organisation global guidelines: GERD global perspective on gastroesophageal reflux disease. Journal of clinical gastroenterology. 2017;51(6):467-78. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 4 2014;63(6):871-80.  Classification Gastroesophageal reflux may cause either esophageal mucosal break, annoying symptoms, or both. It is classified into: - Erosive GERD with an esophageal mucosal break (Los Angeles classification of erosive esophagitis). - Non-erosive GERD with symptoms alone. Hunt R, Armstrong D, Katelaris P, Afihene M, Bane A, Bhatia S, et al. World gastroenterology organisation global guidelines: GERD global perspective on gastroesophageal reflux disease. Journal of clinical gastroenterology. 2017;51(6):467-78. Iwakiri K, Kinoshita Y, Habu Y, Oshima T, Manabe N, Fujiwara Y, et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. Journal of gastroenterology. 2016;51(8):751-67. Symptoms Symptoms may be intermittent (less than two episodes per week) or frequent (two or more episodes per week). Symptoms are considered mild or moderate/severe based on whether they impair quality of life. 6 The most common endoscopic finding associated with esophageal mucosal injury is reflux esophagitis. 7  Pathophysiology Acid (pH