Simple Reflux, GER-Disease and its extra-esophageal manifestations

1. Simple Reflux,
GER-Disease and its
extraesophageal manifestations
(Dr. Santosh R. Achwani)
ACCESS Clinic DIP 2

2. Definition of GER & GER-Disease

3. What is GERD
► A condition that occurs when the
lower esophageal sphincter
(LES) does not close properly
and stomach contents leak back,
or reflux, into the esophagus.
► Patulous LES.
► (GER) Simple Reflux: Process
(Spont/Once in a while/recurrent)
► Disease: When process happens and
causes effects on body functioning,
distress (mucosal changes, symptoms)

4. Prevalence of GERD

5. Prevalence of GERD
Approximately 20% of adults have frequent
"classic" symptoms of gastroesophageal reflux
(GER):
► Heartburn
► Regurgitation (reflux)
► Often chronic and relapsing
Clinical Course

6. Pathophysiology of GERD

7. How is GERD caused?
► Inappropriate relaxation of
LES (Sphincter looses
functionality)
► Primary: Idiopathic (No clear
Mechanism, ? Changes in the
tone of smooth muscle
sphincter)
► *RFs *MC
► Secondary: Accountable to
disease process. E.g: hiatal
hernia, Scleroderma, PUD,
Trauma etc

8. Risk Factors of Primary GERD

9. Risk Factors that may contribute to GERD
► Drinks (Caffeinated, Alcohol, Tea, Coffee)
► Overweight
► Pregnancy
► Smoking
► Irritant Food (Acidic: Soya sauce, Vinegar,
Oily, Chinese sauces, Indian spices)
► Lack of exercise
► Tighter clothes
► Habits: Sleeping immediately after food

10. Certain foods can be associated with
recurrent reflux events (GERD)
► Heavy to digest food (Meat heavy dishes, low water
► Citrus fruits
► Chocolate
► Drinks with caffeine
► Fatty and fried foods
► Garlic and onions
► Mint flavorings
► Spicy foods
► Tomato-based foods, like spaghetti sauce, chili, and pizza

11. Clinical Manifestations of GERD

15. Classification of GERD &
GERD related disorders

16. ?
GI: Reflux s/s GI: Esophageal s/s Exrtra - GI s/s

17. Diagnosis: GERD and Reflux
associated disorders

18. How is GERD diagnosed?
► Review of symptoms (H/O) and a complete physical
examination (P/E), with Special attention to alarming
symptoms (Red Flags)
► The response of symptoms to an empirical trial of anti-reflux
therapy (Therapeutic diagnosis)
► 1. Barium swallow (Initial)
► 2. Endoscopy (Esophagoscopy, Initial)
► 3. Ambulatory pH monitoring
(24hr pH monitoring)***
► 4. Esophageal manometry
► Clinical

19. Diagnostic Investigations

20. 1.

21. 2.

22. 3.

23. 4.

24. Red Flags in general practice for
GERD related disorders
while making the diagnosis

26. Goals of Treatment
in GERD spectrum

28. Treatment Options

29. How is GERD treated?
► 1. Lifestyle Changes
► 2. Medications
► 3. Surgery
► 4. Endoscopic options

30. Treatment Goals
1.

31. Medications
► Antacids:
 Maalox,
 Mylanta
 Pepto-Bismol
 Rolaids
► Foaming agents
 Gaviscon
► H2 blockers
 Cimetidine (Tagamet )
 Famotidine (Pepcid)
 Nizatidine (Axid)
 Ranitidine (Zantac 75)
► PPIs
Magnesium salt can lead to diarrhea, and
aluminum salts can cause constipation
2.

32. Treatment Goals

33. Treatment Goals

34. Treatment Goals

35. Treatment Goals

36. Treatment Goals

37. Treatment Goals
3. Surgery

38. Complications of GERD
4.

39. Treatment Goals

40. 1. Erosive Esophagitis

41. Treatment Goals
2.

42. Treatment Goals
3.

43. 4. Esophageal
Adeno Ca

44. Management Cycle for
patients in GP

45. Thank you

46. Thank you