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GERD Jaspreet Kaur 1488 MD 4
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Table of Contents EPIDEMIOLOGY PATHOGENESIS RISK FACTORS COMPLICATIONS
SIGNS AND SYMPTOMS CLINICAL FINDINGS LAB DIAGNOSIS PREVENTION TREATMENT
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Epidemiology Approximately 10% of adults have GERD daily
Approximately 80% of pregnant women have GERD Hiatal hernia present in 70% of people with GERD 10-15% GERD may lead to Barrett’s Esophagus 0.5% of these cases per year many lead to adenocarcinoma
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Pathogenesis Transient relaxation and low basal tone of lower esophageal sphincter (LES) Reflux of acid and bile into the distal esophagus Ineffective esophageal clearance of reflux material Impaired gastric emptying Gastric hypersecretion
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Gastro-esophageal Reflux Disease (GERD)
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Risk Factors Smoking, alcohol
Caffeine, greasy and spicy foods, chocolate, peppermint Lying down after eating Pregnancy, over weight, obesity – increased pressure on abdomen Hiatal hernia – lower pressure in esophageal sphincter Certain drugs: Calcium channel blockers, antihistamine, sedatives, antidepressants, painkillers
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Complications Esophagitis Esophageal Strictures Anemia
Respiratory problems Barrett’s Esophagus Esophageal Cancer
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Signs and Symptoms Heart burn Hoarseness of voice
Coughing and wheezing Bad breath and bad taste Difficulty or painful swallowing Bloating with belching Nausea / vomiting Tooth erosion
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Clinical Findings Non-cardiac chest pain Heartburn, indigestion
Nocturnal cough, nocturnal asthma Acid injury to enamel Early satiety, abdominal fullness Regurgitation Barrett's esophagus – depending on severity
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Diagnostic Tests Esophageal Endoscopy and Biopsy
Twenty-hour esophageal pH monitoring Most accurate procedure to detect acid reflux Record of foods eaten, the time and quantity Manometry – only prior to surgery LES pressure < 10 mm Hg Endoscopy procedure will diagnose GERD if it is moderate to severe
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Top - strictures Bottom left hiatal hernia Bottom right ulcer
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Prevention and Non-Pharmacological Treatment
Diet management Avoid foods that lower LES tone: chocolate, coffee, peppermint, fatty foods, alcohol Avoid drugs that lower LES tone: EtOH, theophylline, Ca-blockers, anti-cholinergics, beta-agonists, alpha-agonists Avoid foods that irritate damaged esophageal lining : citrus fruits and juices, tomato, pepper
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Prevention and Non-Pharmacological Treatment
Quit smoking and alcohol intake Loose weight if obese Avoid large meals Avoid tight clothing Avoid lying down for two hours after eating and eat dinner at least two hours before bedtime Raise the head of the bed tobacco inhibits saliva production and may also stimulates stomach acid production and relaxes LES
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Pharmacological Treatment
Short-term Antacids - relieve symptoms of GERD, neutralizes stomach acid OTC Antacids: Maalox, Rolaids, Mylanta H2 Blockers – decrease acid production Cimetidine, Nizatidine, Ranitidine Long-term Proton Pump Inhibitors – lowers parietal cells HCl production Omeprazole, pantoprazole Pro Kinetics - to empty stomach content faster Bethanechol, Metoclopramide Antibiotics - empty stomach faster with lesser side affect Surgery - Fundoplication procedure, gastric wrap around the gastroesophageal junction, increases pressure on LES surgery is recommended if symptoms of GERD don’t improve with lifestyle changes or medicines.
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References topics/digestive-diseases/ger-and-gerd-in- adults/Pages/overview.aspx Goljan, Edward F. Pathology. 3rd ed. Philadelphia, PA: Mosby/Elsevier, Print. National Institute of Diabetes and Digestive and Kidney Diseases: "Heartburn, Gastroesophageal Reflux, and Gastroesophageal Reflux Disease (GERD)." Pluta, R. Journal of the American Medical Association, May 18, American College of Gastroenterology: "Understanding GERD."
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