Gastroesophageal Reflux Gastroesophageal Reflux Disease (GERD)Disease (GERD)

Dr. Gehan Mohamed Dr. Abdelaty ShawkyDr. Gehan Mohamed Dr. Abdelaty Shawky

Objectives:Objectives:

• Definition of GERD• Pathophysiology of GERD• Clinical Manisfestations• Diagnostic Evaluation• How to modify life style to decrease effects of

GERD• Complications of GERD.

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

* 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:ObesityPregnancy SmokingConnective tissue disorders, such as scleroderma

Hiatal herniaDelayed stomach emptying Zollinger-Ellison syndrome

*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 swallowing4. Extra-esophageal manifestations: laryngitis, chronic cough

*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)

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.

* Complications of GERD:

• Erosive esophagitis• Stricture of esophagus due to healing by

fibrosis.• Barrett’s esophagus

• Erosive esophagitis:– Responsible for 40-60% of GERD symptoms

• Esophageal stricture–Result of healing

of erosive esophagitis–May need

dilatation

• 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.

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