06. GASTRPESOPHAGEAL REFLUX DISEASE

Dr TRẦN NGỌC ÁNH Hà Nội Medical University Gastro Esophageal Reflux Disease Objective 1.Recognize the typical clinical presentation for GERD 2.Understand pathophysiology ofGERD 3.Describe an appropriate diagnostic plan 4.Prescribe an appropriate therapeutic regime GERD- Dr Trần Ngọc Ánh GENERAL CONSIDERATIONS  One of the most prevalent GI disordes: 15% heartburn , regurgitation 1time/week. 7% symptoms daily  GERD: the acidified liquid content of the stomach up intothe esophagus  GERD may damage the lining of the esophagus- inflammation, although usually it does not  The symptom of uncomplicated GERD: hearburn, regurgitation and nausea  GERD may be diagnosed or evaluated by a trial of treatment, endoscopy, examination the throat, larynx, 24h esophageal acid testing, esophageal motility testing, emptying studies, esophageal acid perfusion GERD- Dr Trần Ngọc Ánh CLINICAL FEATURES 1.Hearburn -A burning pain (sharp or pressure like) in the middle of the chest. It may start high in the abdomen or may extend up into the neck, extend to the back -More common after meals, lie down -Episodes: infrequently, or frequently 2.Regurgitation -Appearance of refluxed liquid in the mouth 3.Nausea -Uncommon -It may be frequent or severe and may result in vomiting GERD- Dr Trần Ngọc Ánh PATHOPHYSIOLOGY GERD- Dr Trần Ngọc Ánh GERD LES abnormalities Hiatal hernias Abnormal esophageal contractions Slow prolonged emptying of the stomach LABORATORY FINDING 1.Endoscopy  Most patient: normal  Esophagitis, erosions, ulcers  Identifi complications of GERD Biopsies  Diagnosing cancers, causes of esophageal inflammation, Barrett’s 2.X rays  To show only the infrequent complications of GERD: Ulcers and strictures GERD- Dr Trần Ngọc Ánh LABORATORY FINDING GERD- Dr Trần Ngọc Ánh LABORATORY FINDING 3.Esophageal acid testing (24H esophageal pH test)  A gold standard for diagnosing GERD  A small tube is passed through the nose and positioned in the esophageus (on the tip is a sensor that senses acid, the other en is attached to a recorder). Each time acide refluxes back in to the esophagus from stomach, it stiumulates the sensor and records the episode of reflux  A newer method for prolonged measurement (48h) of acid exposure in the esophagus utilizes a small capsule GERD- Dr Trần Ngọc Ánh 24H esophageal pH test GERD- Dr Trần Ngọc Ánh LABORATORY FINDING 4.Esophageal motility testing  How well the muscles of the esophagus are working  A thin tube is passed through a nostril, into the esophageus-sensors that sense pressure; the other end is attached to a recorder that record pressure 5.Gastric emptying studies  How well food empties from the stomach  The patient eats meal that is labeles with a radioactive substance. A sensor is placed over the stomach to measure how quickly the radioactive substance in the meal empties from the stomach GERD- Dr Trần Ngọc Ánh [...]... Determine if chest pain is caused by acid reflux  A thin tube is passed through on nostril, into the middle of the esophagus A dilute, acid solution and a physiologic salt solution are alternately poured through the catheter into the esophagus  If the perfusion provokes usual pain and perfusion of the salt produces no pain The patient’s pain is caused by acid reflux GERD- Dr Trần Ngọc Ánh DIAGNOSIS... particularly related eating Elevation of the upper body at night generally is recommend for all patients Reflux also occurs less frequently when patients lie on their left rather than their right sides GERD- Dr Trần Ngọc Ánh TREATMENT 2.GERD Diet Smaller, earlier evening meals may reduce the amount of reflux These foods should be avoided(↓pressure in the LES) Chocolate Perppemint Alcohol Certainated... therapeutic trial with a PPI such as Omeprazole 40m bid for 1 week, provides support for the diagnosis of GERD  The diagnostic approach to GERD Documentation of mucosal injury Documentation and quantitation of reflux Definition of the pathophysiology GERD- Dr Trần Ngọc Ánh COMPLICATIONS Ulcers Stricture Others GERD- Dr Trần Ngọc Ánh Barrett’s esophagus TREATMENT Life style changes+ Diet Internal medecine Surgery... at bedtime  Metoclpramide, Domperidone, Elthon 5.Foam barries  Composed of an antacid an a foaming agent: the antacid bound to the foam the stomach is distended and when lying down, both times when reflux is more likely to occur  Not often used as the first or only treatment for GERD Added to other drugs  Gaviscon GERD- Dr Trần Ngọc Ánh TREATMENT 5.Surgery  Are effective in treating the symptoms . Dr TRẦN NGỌC ÁNH Hà Nội Medical University Gastro Esophageal Reflux Disease Objective 1.Recognize the typical clinical presentation for GERD 2.Understand pathophysiology. is attached to a recorder). Each time acide refluxes back in to the esophagus from stomach, it stiumulates the sensor and records the episode of reflux  A newer method for prolonged measurement. common after meals, lie down -Episodes: infrequently, or frequently 2.Regurgitation -Appearance of refluxed liquid in the mouth 3.Nausea -Uncommon -It may be frequent or severe and may result in