Medicne

GERD:
it stand for Gastro-Espophageal Reflux Disease.

• Definition:

Reflux of gastric contents to the esophagus causing severe symptoms affecting life or complications. if there's no severe symptom affecting life or any complications this is called reflux.

Risk factors: 
Pregnancy, obesity, fat, chocolate, coffee, alcohol ingestion, large meals Cigarette smoking, drugs like antimuscarinic, calcium-channel blockers, nitrates, systemic sclerosis, after treatment for achalasia(Ca) and hiatus hernia.

• Clinical presentation:

- Esophageal Symptoms:

Heart burn (increased with bending forward and after meals, decreased by antacids), regurgitation, water brash (increase of saliva secretion by salivary gland due to irritation of the salivary glands by acid).

- Extra-oesophageal Symptoms :

Asthma, hoarseness (due to laryngitis), teeth decay, chronic bronchitis and chronic sinusitis.

• Complications:

Reflex esophagitis (appear clinically as odynophagia), peptic stricture due to fibrosis (appear clinically as dysphagia) and  Barrett's esophagus (can change to adenocarcinoma).

• Diagnosis:

Gold standard is 24 hrs PH monitoring.

• Management:

- Life style modification (frequent small meals, no late meals, bed elevation, weight loss, avoid drugs and meals that increase GERD).

- Medical: Antacids or PPIs.

- Surgical: Nissen's fundoplication.

- Note:

Treatment of H.pylori is not effective in pt. with GERD. Because this treatment will not tighten the LOS.

Sources:

-      Oxford textbook.

-      Dr.Mosab Kibreet lectures note.

-      MRCP notes by SUDA MEDICA.