Its an overview about Gastro-Esophageal Reflux Disease, mainly focused on Clinical features, Role of Investigation, Diagnostic Criteria, Management plan.
It was mainly prepared for a scientific seminer. It may help others as well.
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Presentation on GERD, Current Status of Diagnosis & Management
1. Dr Md Mamunul Abedin Shimul
MBBS, BCS(Health)
Medical Officer (Dept of Medicine)
250 bedded General Hospital, Jamalpur
Scientific Partner:
Organized by:
BMA, Jamalpur
2.
3.
4. Dr Md Mamunul Abedin Shimul
MBBS, BCS(Health)
Medical Officer (Dept of Medicine)
250 bedded General Hospital, Jamalpur
Scientific Partner:
Organized by:
BMA, Jamalpur
5. WHAT IS GASTRO-ESOPHAGEAL REFLUX DISEASES
(GERD) ? (American College of Gastroenterology)
Symptoms OR Mucosal Damage
produced by the abnormal reflux
of gastro-duodenal contents
into the esophagus.
6. A 32 yr old man with a body mass index of 32 kg/m2 consults his family
physician with a long history of heartburn & frequent use of over-the-counter
antacids. The family physician prescribes a 1-month course of omeprazole,
which cures his symptoms but they soon return after stopping the
Omeprazole. The family physician refers him for an upper GIT endoscopy,
which shows evidence of a small hiatus hernia and Barrett’s esophagus.
Which statement is true?
QUIZ
A. Acid is the only refluxate that causes injury to the lower esophagus
B. GERD can be reliably diagnosed by symptoms
C. Most patients who develop esophagitis, Barrett’s Esophagus or
Peptic Strictures have a Hiatus Hernia
D. Patients are invariably obese
E. The incidence of GERD is decreasing in most populations
7. PHYSIOLOGY
LES is tonically contracted under normal
circumstances
Esophageal Peristaltic Waves - efficiently
clear the gullet
Alkaline Saliva – neutralizes residual acid
8. PATHOPHYSIOLOGY
Reduced LES tone
Diet – Relax LES
Defective Esophageal
Peristaltic Waves
Defective Gastric Emptying
Gastric Contents
↑ed Abdominal Pressure
Hiatus Hernia
9. PATHOPHYSIOLOGY
Gastro-esophageal reflux disease develops when the
esophageal mucosa is exposed to gastro-duodenal
contents for prolonged periods of time – causes
symptoms & some cases causing Esophagitis.
Almost all patients who develop esophagitis, Barrett’s
esophagus or peptic strictures have a hiatus hernia.
Pepsin & Bile also contribute to mucosal injury.
Dietary fat, Chocolate, Alcohol, Tea, Coffee relax LES
10. Most Common: (50%)
Heartburn (A burning feeling in
the chest)
Regurgitation
Often occurs after Meals
Provoked by – Bending, Straining, Heavy Lifting, Lying Down
17. INVESTIGATIONS
Endoscopy of Upper GIT
-to exclude other GIT diseases
-to identify complications
A normal endoscopy in a patient with
compatible symptoms should not prevent
giving Rx of GERD
18. INVESTIGATIONS
Twenty-four-hour pH monitoring
-if the diagnosis is Unclear
-Surgical intervention is under
consideration
This involves tethering a slim catheter with a
terminal radiotelemetry pH-sensitive probe
above the gastro-oesophageal junction.
A pH of less than 4 for more than 6-7% of the
22. Lifestyle Modifications:
• Reduction of weight
• Change food habit
-avoid eating or drinking chocolate, coffee, peppermint, greasy
or spicy foods, tomato products, and alcohol.
-eat small, frequent meals;
• Stop Smoking
• Elevation of the bed head
-Using extra pillows will not help GERD.
• Avoidance of Late meals
• Avoid bending or stooping positions
23. MEDICAL THERAPY:
• Symptomatic Relief by -
• ANTACIDS & ALGINATES
• DOMPERIDONE
• H2-receptor Antagonist – does not heal Oesophagitis
• Long-Term PPI therapy
24. Long Term PPI therapy is associated with-
-Reduced absorption of Iron, Vit B12, Magnesium
-A small but increased risk of Osteoporosis &
Fractures
-Predispose to Enteric infections with Salmonella,
Campylobacter & Clostridium difficile
-Increased risk of Helicobacter associated Gastric
Mucosal Atrophy
25. SURGERY:
• Failed to respond to Medical Therapy
• Patient unwilling to take long term PPI
30. A 32 yr old man with a body mass index of 32 kg/m2 consults his family
physician with a long history of heartburn & frequent use of over-the-counter
antacids. The family physician prescribes a 1-month course of omeprazole,
which cures his symptoms but they soon return after stopping the
Omeprazole. The family physician refers him for an upper GIT endoscopy,
which shows evidence of a small hiatus hernia and Barrett’s esophagus.
Which statement is true?
QUIZ
A. Acid is the only refluxate that causes injury to the lower esophagus
B. GERD can be reliably diagnosed by symptoms
C. Most patients who develop esophagitis, Barrett’s Esophagus or
Peptic Strictures have a Hiatus Hernia
D. Patients are invariably obese
E. The incidence of GERD is decreasing in most populations