View
232
Download
0
Category
Preview:
Citation preview
8/12/2019 GERD Pharos2
1/21
By Kunkun Achmad MS
GastroEsophageal
Reflux isease
8/12/2019 GERD Pharos2
2/21
DEFINISI The Montreal Definition :
A condition thatdevelops when the
reflux of stomachcontents causestroublesome symptomsand/or complications
Vakil N, et al. Am J Gastroenterol. 2006
8/12/2019 GERD Pharos2
3/21
GERD Pathophysiology :
3-Part Process
1) Decreased basal lower
esophageal sphincter (LES)pressure
2) Decreased acid clearance3) Refluxate of acid and pepsin
injures the esophageal mucosa
8/12/2019 GERD Pharos2
4/21
2 Groups of GERD
Erosive esophagitis3-5% Asian countries (14-15% Taiwan andJapan)10-20% Western countries
Non-erosive Reflux Disease (NERD)90% asian countries
70% Western countries
Fock KM et al. J Gastroenterol Hepatol 2008
8/12/2019 GERD Pharos2
5/21
Classic Symptoms
Heartburn
Regurgitation
Malfertheiner P, et al.Dig Dis. 2008;26(3):231-6
8/12/2019 GERD Pharos2
6/21
Atypical/Extra-esophageal
ManifestationsAtypical Extra-esophageal Chest pain Oral - Pulmonary Chronic
Epigastric pain Dental erosion cough Asthma
Nausea Pharyngo-laryngeal AspirationPulmonary
Pharyngitis/Laryngitis fibrosis
Hoarseness
Globus sensation - OtherSore throat Sleep
abnormalities
Vocal cord polyps
Posterior laryngitis
8/12/2019 GERD Pharos2
7/21
DIAGNOSTIC OF GERD
8/12/2019 GERD Pharos2
8/21
International Consensus
GERD is a symptom-baseddiagnosis, and hence symptomevaluation will remain theprimary means by whichtreatment decisions are madefor patients with suspectedGERD
Hunt R, et al. Dis Esophagus.2009
8/12/2019 GERD Pharos2
9/21
8/12/2019 GERD Pharos2
10/21
Tests to diagnose GERD
Proton pump inhibitor test (PPI Test)
Endoscopy
Ambulatory 24-hour esophageal pHmonitoring
Esophageal manometry
Radiography
8/12/2019 GERD Pharos2
11/21
Therapeutic Trial: a diagnostic tool
(?)
The use of a short course ofhigh dose PPI as a test in
diagnosing GERD
To achieve a significant
symptomatic improvement within ashort period of drug administration
Fass R, Hepato-Gastroenterol, 2001
8/12/2019 GERD Pharos2
12/21
THERAPEUTIC
MODALITIES
8/12/2019 GERD Pharos2
13/21
8/12/2019 GERD Pharos2
14/21
Lifestyle Modifications
Avoid Caffeine
Sodas * Fatty food
* Alcohol* Smoking
* Citrus & tomatoes
* Spicy foods
8/12/2019 GERD Pharos2
15/21
Lifestyle Modifications
Avoid assuming
supine position for 3-4
hours after meals
Elevate head whilesleeping
Weight management
Avoid tightening your
belt or girldles
8/12/2019 GERD Pharos2
16/21
MEDICAL
MANAGEMENT
8/12/2019 GERD Pharos2
17/21
Acid-Suppression Therapy
H2RAs / H2 Blockers
* Ranitidine, famotidine, nizatidine,
and cimetidine
PPIs
* Omeprazole, esomeprazole,
lansoprazole, pantoprazole, and
rabeprazoleAcid suppression is the stronghold in
GERD management
8/12/2019 GERD Pharos2
18/21
Treatment Duration
48 weeks for Typical GERD
6 months forAtypical GERD (withextra-esophageal manifestations)
8/12/2019 GERD Pharos2
19/21
RECURRENCE
May employ on-demand strategy of
treatment
8/12/2019 GERD Pharos2
20/21
Surgical TreatmentAntireflux surgery (Nissen/Toupet
fundoplication) is offered to patients in
the hope of obviating the need for
continuous medical therapy. Positive predictors:
* good response to medical therapy
* less than 50 yrs old* presence of typical GERD
symptoms
8/12/2019 GERD Pharos2
21/21
Recommended