1. GERD
Jaspreet Kaur
1488
MD 4

2. Table of Contents EPIDEMIOLOGY PATHOGENESIS RISK FACTORS COMPLICATIONS
SIGNS AND SYMPTOMS
CLINICAL FINDINGS
LAB DIAGNOSIS
PREVENTION
TREATMENT

3. 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

4. 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

5. Gastro-esophageal Reflux Disease (GERD)

6. 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

7. Complications Esophagitis Esophageal Strictures Anemia
Respiratory problems
Barrett’s Esophagus
Esophageal Cancer

9. 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

10. 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

11. 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

12. Top - strictures
Bottom left hiatal hernia
Bottom right ulcer

13. 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

14. 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

15. 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. 

16. 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."