1. Gastro Esophageal Reflux Disease GERD

2. GERD
GERD resulting in heartburn affects approximately 30% of the general population

3. Factors Associated with the Development of GERD
Gastroesophageal reflux
Defective
Esophageal Clearance
Dietary
Factors
Hiatus Hernia
Abnormal lower Esophageal Sphenicter
Reduced tone
Abnormal relaxation
Delayed gastric
Emptying
Increased
intra-abdominal
pressure
Reflux of
acid pepsin
(bile)
Factors Associated with the Development of GERD

4. Abnormalities of Lower Esophageal sphincter
Some patients with GERD have reduced lower esophageal sphincter tone
Other patients have normal basal sphincter tone, but reflux occur in response to frequent episodes of inappropriate sphincter relaxation

5. Hiatus Hernia Occurs in 30% of the population over the age of 50 years
Often asymptomatic
Heartburn & regurgitation may occur
Gastric volvulus may complicate large para-esophageal hernias
It causes GERD because:
The pressure gradient between the abdominal & thoracic cavities is lost
The oblique angle between the cardia and esophagus disappears
Almost all patients who develop esophagitis, Barret’s esophagus or peptic strictures have hiatus hernia

6. Delayed esophageal clearance
Defective esophageal peristaltic activity
It is a primary abnormality
Poor esophageal clearance leads to increased acid exposure time

7. Defective gastric emptying
Gastric Contents
Gastric acid is the most important esophageal irritant
There is close relationship between acid exposure time & symptoms
Defective gastric emptying

8. Dietary & environmental factors
Material that cause relaxation of the lower esophageal sphincter:
Dietary fat
Chocolate
Alcohol
Coffee
There is little evidence to incriminate smoking or NSAIDs as causes of GERD

9. Clinical features Heartburn & Regurgitation:
Often provoked by:
Bending
Straining
Lying down
Waterbrash (Salivation due to reflex salivary gland stimulation as acid enter the gullet)
History of weight gain
Chocking due to laryngeal irritation by refluxed fluid
Odynophagia & dysphagia
Atypical chest pain which:
Might be severe
Might mimic anginal chest pain
Is due to reflux induced esophageal spasm.