1. Gastroesophageal reflux disease

2. 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

3. Montreal Classification of GERD

4. Pathogenesis of GERD Impaired Tissue Resistance
Impaired Esophageal Clearance
Hiatal Hernia
Decreased LES Resting Tone
Delayed Gastric Emptying

5. 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

6. 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

7. 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

8. GERD Diagnosis
There is no single diagnostic gold standard for GERD

9. GERD Diagnosis: Menu Empiric trial Barium esophagram Endoscopy
Manometry
pH testing
Impedance

10. Alternative Diagnosis in GERD
Coronary artery disease
Gallstones
Gastric /esophageal cancer
Peptic ulcer disease
Esophageal motility disorders
Pill induced esophagitis
Eosinophilic esophagitis

11. Treatment
Lifestyle (e.g. clothes, earyly supper, body position during sleeping, food) Drugs (antiacids, PPI, H2b) Fundoplication