Gerd
Gerd
Gerd
AL REFLUX
DISEASE (GERD)
Summer 2013
Gastroesophageal Reflux
Disease (GERD)
Gastroesophageal reflux (GER) is defined as the
retrograde passage of gastric contents from the
stomach into the esophagus. It is primarily the result
of transient relaxation of the LES.
4) Gastric Emptying
5) Mucosal Resistance
ysphonia
Other inusitis
S
tricture (location, length)
M
ass (location, length)
B
irds beak
H
iatal hernia (size, type).
Limitations
D
etailed mucosal exam for erosive esophagitis,
Barretts esophagus
Endoscopy
larm symptoms
reoperative evaluation
time pH < 4
eMeester score
Symptom
correlation
Ambulatory 24 hr. pH Monitoring
Normal
GERD
Wireless, Catheter-Free Esophageal pH
Monitoring
Potential Advantages
Improved patient
comfort and acceptance
Continued normal work,
activities and diet study
Longer reporting periods
possible (48 hours)
Maintain constant probe
position relative to SCJ
Esophageal Manometry
T
he presence of Barrett esophagus is an indication
for surgery. Whether acid suppression improves
the outcome or prevents the progression of Barrett
esophagus remains unknown, but most authorities
recommend complete acid suppression in patients
with histologically proven Barrett esophagus.
he presence of extraesophageal manifestations of
gastroesophageal reflux disease (GERD) may indicate
the need for surgery. These include the following: (1)
respiratory manifestations (eg, cough, wheezing,
aspiration); (2) ear, nose, and throat manifestations
(eg, hoarseness, sore throat, otitis media); and (3)
dental manifestations (eg, enamel erosion).
oung patients
oor patient compliance with regard to medications
ostmenopausal women with osteoporosis
atients with cardiac conduction defects
ost of medical therapy
Treatment Antacids
A
dditional H2 blocker therapy has been reported to be useful in
patients with severe disease (particularly those with Barrett
esophagus) who have nocturnal acid breakthrough.
M
ore effective than placebo and antacids for relieving heartburn in
patients with GERD
F
aster healing of erosive esophagitis when compared with placebo
C
an use regularly or on-demand.
Treatment
AGENT EQUIVALENT DOSAGE
DOSAGES
Cimetadine 400mg twice daily 400-800mg twice daily
Tagamet
Pepcid
Axid
zantac
Treatment: PPI
Proton Pump Inhibitors
peed of healing
6%/wk vs 12%/wk
Effectiveness of Medical
Therapies for GERD
Treatment Response
Lifestyle modifications/antacids 20 %
H2-receptor antagonists 50 %
Single-dose PPI 80 %
Improve compliance
Optimize pharmacokinetics
Barretts esophagus
Adenocarcinoma
Erosive Esophagitis
Peptic Stricture