Dubravka Šipuš, 2nd year 2013/2014 Mentor: A. Žmegač Horvat.
GastroEsophageal Reflux Disease (GERD) Marijo Čukelj Mentor: A. Žmegač Horvat.
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Transcript of GastroEsophageal Reflux Disease (GERD) Marijo Čukelj Mentor: A. Žmegač Horvat.
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