1. Gastroesophageal Reflux Disease (GERD)
Dr. Gehan Mohamed Dr. Abdelaty Shawky

2. Objectives: Definition of GERD Pathophysiology of GERD
Clinical Manisfestations
Diagnostic Evaluation
How to modify life style to decrease effects of GERD
Complications of GERD.

3. * Definition: inflammation of the lower part of the esophagus due to abnormal reflux of gastric contents into the esophagus
Often chronic and relapsing

4. * Pathophysiology:
GERD is due to weakness of the lower esophageal sphincter (LES) leading to reflux of the acidic gastric content to the lower part of the esophagus.
Risk factors:
Obesity
Pregnancy
Smoking
Connective tissue disorders, such as scleroderma
Hiatal hernia
Delayed stomach emptying
Zollinger-Ellison syndrome

7. * Clinical Manifestations:
1. Heartburn: retrosternal burning discomfort.
2. Regurgitation: effortless return of gastric contents into the pharynx without nausea, or abdominal contractions. To be differentiated from vomiting.
3. Dysphagia: difficulty swallowing
4. Extra-esophageal manifestations: laryngitis, chronic cough --

8. * Morphological features of GERD:
* Grossly: the lower part of the esophagus is red, and may shows erosions.
* Microscopically:
1. Inflammatory cellular infiltrate in the squamous epithelium including neutrophils, esinophils and lymphocytes.
2. Basal cell hyperplasia.
3. Acute inflammation of the sub epithelium (lamina propria)

12. Eosophagogastrodudenoscopy
Indications for Endoscopy (with biopsy if needed)
In patients with alarm signs/symptoms
Those who fail a medication trial
Those who require long-term treatment.
Absence of endoscopic features does not exclude a GERD diagnosis.

14. * Complications of GERD:
Erosive esophagitis
Stricture of esophagus due to healing by fibrosis.
Barrett’s esophagus

15. Erosive esophagitis:
Responsible for 40-60% of GERD symptoms --

16. Esophageal stricture Result of healing of erosive esophagitis
May need dilatation
4-20% of patients

17. Barrett’s Esophagus:
Transformation of the stratified squamous epithelium of the lower end of the esophagus into intestinal epithelium (glandular metaplasia).
The clinical significance of Barrett’s Esophagus is that it is Associated with the development of dysplasia and subsequently adenocarcinoma.
--1950—Norman Barrett %
--black arrow squamo-columnar jxn—Z-line
--Z-line has undulating smooth contours
--green arrow—gastric columnar epithelium above round black sphincter
--red arow—pink white esophageal squamous epithelium
--RFs—male, smoker, age, obese

20. Thanks