1. Gastro-esophageal Reflux disease (GERD)
Heba Ahmed Faheem

2. Intended Learning objectives (ILOs)
To describe the definition of GERD.
To understand the mechanism of GERD.
To understand the clinical picture and Complications of GERD.
To describe the required investigations to diagnose GERD.
To apply how to Approach a patient with GERD symptoms and the management outlines.

3. Case study
N.S is a 45 year old man who comes to the office with acid indigestion and stomach pains every night. On doing his assessment, you find that he smokes 1 pack of cigarettes every day, has a BP of 146/92, and has a BMI of 34. He is diagnosed with GERD and the provider gives him PPI to take daily

4. What are risk factors for GERD ?
What patient education would you do regarding his risk factors ?
When should he take PPI ?

5. Introduction

8. Definition of GERD
GERD is a common clinical problem that occurs when acid and food from stomach reflux into the esophagus and throat.

12. Mechanism of GERD
The major physiologic mechanisms to protect against esophageal acid injury include clearing mechanisms (peristalsis), a competent LES, and intact gastric emptying
A breakdown in these protective mechanisms can lead to symptomatic GERD

14. Clinical picture
Heartburn and regurgitation
Non-cardiac chest pain
(N.B. A cardiac cause should be excluded in patients with chest pain before the commencement of a gastrointestinal evaluation).

15. Clinical picture
Dysphagia can occur with GERD
{But additional evaluation is required to rule out an underlying pathology (e.g, ring , web, malignancy or motility disorder)}

17. Complications of GERD
Erosive oesphagitis
Stricture (so-called peptic stricture)
Barrett oesphagus And oesphageal cancer

19. Investigations
GERD is a clinical diagnosis.
Upper Endoscopy is recommended in
Presence of alarm symptoms (dysphagia, unintentional weight loss, hematemesis or melena) and
For screening of patients at high risk for complications.

23. Investigations
Investigations for detection of complications:
Barium radiographs
(Not for GERD, used for evaluation of dysphagia)

24. Normal Barium Swallow
Oesphageal Stricture

25. Investigations
Esophageal manometry is recommended for preoperative evaluation, but has no role in the diagnosis of GERD.
(To rule out achalasia / scleroderma like oesphagus preoperative)

27. Management of GERD
Life style recommendations
Weight loss
Head of bed elevation
Avoidance of meals 2 – 3 h before bedtime

28. Management of GERD
Life style recommendations
Medical treatment
8 weeks PPI once daily(شهرين)
8 weeks PPI Twice daily
Maintance PPI
H2 blocker
Prokintics

29. Management of GERD
Surgical options for GERD
Indications for anti-reflux surgery include:
Patient preference to stop taking medication
Medication side effects
Large hiatus hernia
And Refractory symptoms despite maximal medical therapy

30. Back To Case study
N.S is a 45 year old man who comes to the office with acid indigestion and stomach pains every night. On doing his assessment, you find that he smokes 1 pack of cigarettes every day, has a BP of 146/92, and has a BMI of 34. He is diagnosed with GERD and the provider gives him PPI to take daily

31. What are risk factors for GERD ?
What patient education would you do regarding his risk factors ?
When should he take PPI ?