GASTRO OESOPHAGEAL REFLUX DISEASE

 GERD (gastroesophageal reflux disease, or chronic acid reflux) is a condition in which acid-containing contents in your stomach persistently leak back up into your esophagus, from stomach.

Risk Factors

1. due to intra gastric pressure - Large meals, chronic cough

2. decreased oesophageal stricture- Alcohol, Smoking Benzodiazepines, Calcium channel blockers, Tricyclic antidepressants, NSAIDs, , previous history of surgery, 

3. Obesity

3. Pregnancy


CLINICAL PRESENTATION

1. Heartburn or a burning sensation in the center of the chest, after meal or after lying down position.

2. Burning chest pain

3.An acid taste in the back of the throat

4.Regurgitation of foods or liquids

5.Nausea and/or vomiting

6. Difficulty swallowing or food getting stuck

7. painful swallowing

8. persistence hoarseness

9. persistence sore throat

10. waking up in the middle of the  night with a choking sensation


HOW IS GERD DIAGNOSED?

A comprehensive history and physical exam will help to diagnose  GERD REFLUX, If you have symptoms of acid reflux but no evidence of complications or more serious disease, a trial of lifestyle modifications and medication may be recommended prior to more invasive testing.

INVESTIGATIONS

1. UPPER ENDOSCOPY

If patient has symptoms like unexplained weight loss, recurrent vomiting, jaundice9 yellowish skin, sclerae) occult or gross gastro intestinal bleeding, palpable mass or adenopathy, family history of gastro intestinal malignancy better to do upper endoscopy.

2. 24 HOUR ESOPHAGEAL PH STUDY

. 24-hour esophageal pH study — This test directly measures the acidity in your   esophagus by endoscopic capsule or catheter method.

3. Esophageal manometry

if your lower esophageal sphincter (or LES) is functioning properly. This test involves swallowing a tube that measures the muscular contractions of your esophagus.




 

What are the complications associated with GERD?


1. Peptic ulcer disease
2. Stricture or  a narrowing of the lining  of the esophagus
3. Lung and throat problems
4. Barrett esophagus
5. Esophageal cancer

TREATMENT

Patients with GERD should limit ethanol , caffeine , chocolate, tobacco use due to to their effects on the Lower Esophageal Sphincter  .and patients may be advised to reduce intake fat and spicy foods.

The treatments for GERD may include food choices, lifestyle changes, medications, and possibly surgery. Initial treatment is frequently with a proton-pump inhibitor such as omeprazole. In some cases, a person with GERD symptoms can manage them by taking over-the-counter drugs

Some guidelines recommend treat symptoms with an H2 antagonist like Cimetidine or Ranitidine,  because of cost and safety concerns.














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