Gastroesophageal Reflux Disease Slater3/26/01Overview of GERD10% of all Americans experience GERDLow mortality rate approximately 1 death per 100,000 personsLargely effects QOL: more than angina, menopause,untreated HTN, mild CHFGERD is defined as:Clinical or histological disorder resulting from gastric materials “refluxing” into the esophagusThis reflux causes a breakdown of the esophageal mucosaPathophysiology of GERDExcessive reflux of gastric juices from the stomach to the esophagus resulting in a breakdown of the defensive mechanisms of the esophagus.This breakdown leads to irritation and injury of the esophageal mucosa. Pathophysiology of GERDCauses of esophageal mucosa breakdown:Transient/spontaneous LES relaxationTransient increase in intra-abdominal pressureAtonic LESLES tone can be caused by certain foods, drugs, hormones, or other physiologic factorsTypical PresentationClassic Symptoms: “Heartburn”Hypersalivation, belching, and regurgitation especially after a large mealAntacids are commonly used to treat this symptomsAtypical PresentationChronic cough, hoarseness, pharyngitis, and angina like painNon-allergic asthmatic symptoms have been reportedFurther work is usually needed Complicated PresentationContinual pain, dysphagia, bleeding, weight loss, choking and chest painDifferentiate from MI or Angina PainFurther work up is necessaryDiagnostic Testing for GERDEndoscopy24 hour pH monitoringBarium esophagogramAcid perfusion test (induce reflux)Treatment Goals Alleviate pain and discomfort associated with the symptoms of GERDDecrease frequency and duration of refluxPromote esophageal healingAvoid complicationsPrevent recurrenceTypes of TreatmentNon-PharmacologicOften used as monotherapy in mild or intermittent heartburn from GERDPharmacologicMay be used in mild cases if uncontrolled from non-pharmacologic treatment aloneAlways used for more severe cases Accompanied by non-pharmacologic treatmentNon-Ph...
