Gastroesophageal reflux disease
Gastroesophageal reflux disease Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus This action can irritate the esophagus, causing heartburn and other symptoms
Montreal Classification of GERD
Pathogenesis of GERD Impaired Tissue Resistance Impaired Esophageal Clearance Hiatal Hernia Decreased LES Resting Tone Delayed Gastric Emptying
The risk factors for reflux include: Alcohol (possibly) Hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities) Obesity Pregnancy Scleroderma Smoking Food: fatty, pepermint and spearmint, onion , coffe
Drugs causing or making worse: Anticholinergics (e.g., for seasickness) Beta-blockers for high blood pressure or heart disease Bronchodilators for asthma Calcium channel blockers for high blood pressure Dopamine-active drugs for Parkinson's Diseases Progestin for abnormal menstrual bleeding or birth control Sedatives for insomnia or anxiety Tricyclic antidepressants
Symptoms: More common symptoms are: Feeling that food is stuck behind the breastbone Heartburn or a burning pain in the chest (under the breastbone) Increased by bending, stooping, lying down, or eating More likely or worse at night Relieved by antacids Nausea after eating Less common symptoms are: Bringing food back up (regurgitation) Cough or wheezing Difficulty swallowing Hiccups Hoarseness or change in voice Sore throat
GERD Diagnosis There is no single diagnostic gold standard for GERD
GERD Diagnosis: Menu Empiric trial Barium esophagram Endoscopy Manometry pH testing Impedance
Alternative Diagnosis in GERD Coronary artery disease Gallstones Gastric /esophageal cancer Peptic ulcer disease Esophageal motility disorders Pill induced esophagitis Eosinophilic esophagitis
Treatment Lifestyle (e.g. clothes, earyly supper, body position during sleeping, food) Drugs (antiacids, PPI, H2b) Fundoplication