Group DFlorendo-Gaspar

Symptoms manifests when gastric acid and other gastric contents backflow into the esophagus →burning sensation “heartburn”

Almost everyone has occasional heartburn usually after meals.

If symptoms occur ≥2 a week for at least 3months, it may be a GERD.  http://www.gerd.com

Harrison’s Principles of Internal Medicine, 17th edition

One of the most prevalent GI disorders. 15% of individuals have heartburn and/or

regurgitation at least once a week 7% - 10% of the population experience

symptoms of heartburn daily. Most cases of heartburn occur because of

excess acid reflux 10% of patients with functional heartburn Many individuals control symptoms with OTC

medications without consulting a medical professional, thus, is likely underreported.

http://www.gerd.com Harrison’s Principles of Internal Medicine, 17th edition

Occurs in all age groups Prevalence increases in people older than

40 y/o No sexual predilection exists (M=F) White males are at a greater risk for

Barrett esophagus and adenocarcinoma than other populations. 8-15% of patients with GERD → adenocarcinoma

50% of patients develop esophagitis GERD is a chronic, but treatable condition,

and it is extremely common.  http://www.gerd.com Harrison’s Principles of Internal Medicine, 17th edition

The LES plays an important role in digestion.

It may open more often than it should or it may open at the wrong times, allowing stomach acid to back up into the esophagus.

This can be extremely painful.

If this continues for a long time, a portion of the esophagus can become “raw.” This is called erosive esophagitis and it can lead to serious medical problems (scarring, bleeding and ulcers)

http://www.gerd.com

Reflux happens when gradient b/w LES and stomach is lost and is usually due to transient or sustained decrease in LES tone.

Transient hypotension of LES is due to: Vagovagal reflex

Harrison’s Principles of Internal Medicine, 17th edition

Sustained hypotension of LES may be due to: Muscle weakness Scleroderma-like diseases Myopathy associated with chronic intestinal

pseudoobstruction Pregnancy Smoking Anticholinergic drugs Smooth-muscle relaxants Surgical damage to the LES, and esophagitis

Harrison’s Principles of Internal Medicine, 17th edition

(1)Increase in gastric volume• After meals with pyloric obstruction,

gastric stasis, acid hypersecretion state(2)Close proximity of gastric

contents to the GEJ• Recumbency, bending down, hiatal

hernia(3)Increase in gastric pressure • Obesity, pregnancy, ascites, tight clothes

Harrison’s Principles of Internal Medicine, 17th edition

1. Reflux esophagitis2. Mild esophagitis3. Erosive esophagitis4. Peptic stricture

Harrison’s Principles of Internal Medicine, 17th edition

• Develops when the damage caused by acid, pepsin, and bile cannot be counteracted by the mucosal defenses

Harrison’s Principles of Internal Medicine, 17th edition

Micsoscopic changes▪ Mucosal infiltration with granulocytes, or

small numbers of eosinophils▪ Hyperplasia of basal cells▪ Elongation of dermal pegs

Harrison’s Principles of Internal Medicine, 17th edition

Mucosal damage with redness, friability, superficial linear ulcers, exudates

• Histology▪ Polymorphonuclear infiltrates▪ Mild eosinophilic infiltrates▪ Granulation tissue .

• May heal by intestinal metaplasia →Barrett’s esophagus

Harrison’s Principles of Internal Medicine, 17th edition

Luminal constriction resulting from fibrosis

2 types:1. Short strictures▪ 1-3 cm ▪ seen in the distal esophagus, near the GEJ

caused by spontaneous reflux

2. Long/Tubular strictures▪ Caused by persistent vomiting or by

prolonged NGT intubationHarrison’s Principles of Internal Medicine, 17th edition

Heartburn

Regurgitation of sour material into the mouth

Induced by the contact of refluxed material with the sensitized or ulcerated esophageal mucosa

Angina like/ atypical chest pain

Mucosal injury

Barium Swallow

Esophagoscopy

Mucosal biopsies

Berstein test

Reflux

Long-term (24–48 h) esophageal pH recording

Patho-

physiologic

factors

Management decisions

Goals of Treatment :1. provide symptom relief2. heal erosive esophagitis3. prevent complications.