Gastroesophageal Reflux Disease (GERD) PDF

Gastroesophageal reflux disease (GERD) gu.edu.eg DEFINITION OF GERD GERD is a common clinical problem that occurs when acid and food from stomach reflux into the esophagus and throat. OCCURS DUE TO breakdown in the protective mechanisms INCLUDING clearing mechanisms (peris...

Gastroesophageal reflux disease (GERD) gu.edu.eg DEFINITION OF GERD GERD is a common clinical problem that occurs when acid and food from stomach reflux into the esophagus and throat. OCCURS DUE TO breakdown in the protective mechanisms INCLUDING clearing mechanisms (peristalsis), a competent LES, and intact gastric emptying GERD Ø Gastroesophageal reflux disease occurs when the amount of gastric juice that refluxes into the esophagus exceeds the normal limit, causing symptoms with or without associated esophageal mucosal injury Ø Dysfunction of the lower esophageal sphincter Ø Delayed gastric emptying Ø Hiatal hernia Ø Obesity as contributing factor Clinical picture of GERD Heartburn and regurgitation Non-cardiac chest pain (N.B. A cardiac cause should be excluded in patients with chest pain before the commencement of a gastrointestinal evaluation). Dysphagia can occur with GERD {But additional evaluation is required to rule out an underlying pathology (e.g, malignancy or motility disorder)}  Investigations Ø GERD Ø GERD is a clinical diagnosis. …..Upper Endoscopy is recommended in q Presence of alarm symptoms (dysphagia, unintentional weight loss, hematemesis or melena) and q For screening of patients at high risk for complications.  Management ü Treatment of gastroesophageal reflux disease involves a stepwise approach. The goals are to: ü Control symptoms ü Heal esophagitis ü Prevent recurrent esophagitis or other complications. ü The treatment is based on lifestyle modification and control of gastric acid secretion through medical therapy with antacids or proton pump inhibitors or surgical treatment with corrective antireflux surgery.  Non pharmacotherapy Lifestyle modifications used in the management of gastroesophageal reflux disease include the following: Losing weight (if overweight) Avoiding alcohol, chocolate, citrus juice, and tomato-based products Avoiding peppermint, coffee, and possibly the onion family Eating small, frequent meals rather than large meals Waiting 3 hours after a meal to lie down Refraining from ingesting food (except liquids) within 3 hours of bedtime Elevating the head of the bed 8 inches Avoiding bending or stooping positions Pharmacotherapy The following medications are used in the management of gastroesophageal reflux disease: Proton pump inhibitors (eg, omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole) H2 receptor antagonists (eg, ranitidine, cimetidine, famotidine, nizatidine) Antacids (eg, aluminum hydroxide, magnesium hydroxide)  Surgical option Transthoracic and transabdominal fundoplications are performed for gastroesophageal reflux disease. Thank You gu.edu.eg