GastroEsophageal GastroEsophageal Reflux Disease (GERD)Reflux Disease (GERD)

Marijo ČukeljMarijo ČukeljMentor: A. Žmegač HorvatMentor: A. Žmegač Horvat

DefinitionDefinition

prolonged reflux of hydrochloric acid prolonged reflux of hydrochloric acid and pepsin in esophagus, oral cavity and pepsin in esophagus, oral cavity and respiratory systemand respiratory system

chronic and relapsing conditionchronic and relapsing condition leads to esophagitis and other leads to esophagitis and other

postinflammatory conditions of postinflammatory conditions of intestinal and respiratory mucosaintestinal and respiratory mucosa

EpidemiologyEpidemiology

developed developed countriescountries

epidemic epidemic proportions; proportions; present in 40% of present in 40% of healthy populationhealthy population

adults: male, over adults: male, over 4040

low mortalitylow mortality

PathophysiologyPathophysiology

dysfunction of LES dysfunction of LES (lower esophageal (lower esophageal sphincter)sphincter)

barrier function: barrier function: prevents reflux by prevents reflux by mutual contraction mutual contraction with diaphragm with diaphragm

retains high retains high pressure during pressure during gastric digestiongastric digestion

Risk factorsRisk factors

prolonged gastric emptyingprolonged gastric emptying obesityobesity pregnancypregnancy hiatal herniahiatal hernia traumatrauma transient LES relaxation - nocturnal, transient LES relaxation - nocturnal,

postprandialpostprandial

Symptoms: Symptoms: HEARTBURNHEARTBURN

- - retrosternal burning pain retrosternal burning pain - may start in - may start in

abdomen and abdomen and extend up extend up into the neckinto the neck

Other symptoms:Other symptoms:

regurgitation -regurgitation - appearance of appearance of refluxed refluxed liquid in liquid in the oral cavitythe oral cavity

globus syndromeglobus syndrome respiratory symptoms – respiratory symptoms – atypical atypical

symptoms connected to asthma, symptoms connected to asthma, hoarseness, hiccoughhoarseness, hiccough

nausea - nausea - resulting in vomitingresulting in vomiting - uncommon symptom - uncommon symptom

Complications:Complications:

chronic esophagitis chronic esophagitis erosive changeserosive changes

strictures strictures DYSPHAGIADYSPHAGIA

Barret’s esopgagusBarret’s esopgagus

dysplasiadysplasia

adenocarcinomaadenocarcinoma

Diagnosis:Diagnosis:

clinicalclinical – evaluation of – evaluation of sypmtoms, excluding sypmtoms, excluding other possible causes other possible causes (pectoral angina)(pectoral angina)

endoscopicendoscopic procedure: procedure:

>esophagogastroscopy >esophagogastroscopy with biopsywith biopsy

pH metricspH metrics: 24-hour : 24-hour intraluminal monitoringintraluminal monitoring

Treatment - non Treatment - non medicament:medicament:

Lifestyle Lifestyle modification:modification:

Medications:Medications:

proton pump inhibitorsproton pump inhibitors H2 antagonistsH2 antagonists antacidsantacids surgical and endocsopic proceduressurgical and endocsopic procedures

References:References:

WikipediaWikipedia Vrhovac: Interna medicinaVrhovac: Interna medicina youtube:youtube:Understanding GERD Understanding GERD

(GERD #1(GERD #1