Lecture Gastro esophageal reflux disease - Dr. Tran Ngoc Anh

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Lecture Gastro esophageal reflux disease help you recognize the typical clinical presentation for GERD 2, understand pathophysiology of GERD, describe an appropriate diagnostic plan, prescribe an appropriate therapeutic regime.

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Nội dung Text: Lecture Gastro esophageal reflux disease - Dr. Tran Ngoc Anh

Gastro Esophageal Reflux Disease Dr TRẦN NGỌC ÁNH Hà Nội Medical University
Objective 1.Recognize the typical clinical presentation for GERD 2.Understand pathophysiology ofGERD 3.Describe an appropriate diagnostic plan 4.Prescribe an appropriate therapeutic regime GERD- Dr Trần Ngọc Ánh
GENERAL CONSIDERATIONS  One of the most prevalent GI disordes: 15% heartburn , regurgitation 1time/week. 7% symptoms daily  GERD: the acidified liquid content of the stomach up intothe esophagus  GERD may damage the lining of the esophagus- inflammation, although usually it does not  The symptom of uncomplicated GERD: hearburn, regurgitation and nausea  GERD may be diagnosed or evaluated by a trial of treatment, endoscopy, examination the throat, larynx, 24h esophageal acid testing, esophageal motility testing, emptying studies, esophageal acid perfusion GERD- Dr Trần Ngọc Ánh
CLINICAL FEATURES 1.Hearburn -A burning pain (sharp or pressure like) in the middle of the chest. It may start high in the abdomen or may extend up into the neck, extend to the back -More common after meals, lie down -Episodes: infrequently, or frequently 2.Regurgitation -Appearance of refluxed liquid in the mouth 3.Nausea -Uncommon -It may be frequent or severe and may result in vomiting GERD- Dr Trần Ngọc Ánh
PATHOPHYSIOLOGY LES abnormalities GERD Slow prolonged emptying of the Hiatal hernias stomach Abnormal esophageal contractions GERD- Dr Trần Ngọc Ánh
LABORATORY FINDING 1.Endoscopy  Most patient: normal  Esophagitis, erosions, ulcers  Identifi complications of GERD Biopsies  Diagnosing cancers, causes of esophageal inflammation, Barrett’s 2.X rays  To show only the infrequent complications of GERD: Ulcers and strictures GERD- Dr Trần Ngọc Ánh
LABORATORY FINDING GERD- Dr Trần Ngọc Ánh
LABORATORY FINDING 3.Esophageal acid testing (24H esophageal pH test)  A gold standard for diagnosing GERD  A small tube is passed through the nose and positioned in the esophageus (on the tip is a sensor that senses acid, the other en is attached to a recorder). Each time acide refluxes back in to the esophagus from stomach, it stiumulates the sensor and records the episode of reflux  A newer method for prolonged measurement (48h) of acid exposure in the esophagus utilizes a small capsule GERD- Dr Trần Ngọc Ánh
24H esophageal pH test GERD- Dr Trần Ngọc Ánh
LABORATORY FINDING 4.Esophageal motility testing  How well the muscles of the esophagus are working  A thin tube is passed through a nostril, into the esophageus-sensors that sense pressure; the other end is attached to a recorder that record pressure 5.Gastric emptying studies  How well food empties from the stomach  The patient eats meal that is labeles with a radioactive substance. A sensor is placed over the stomach to measure how quickly the radioactive substance in the meal empties from the stomach GERD- Dr Trần Ngọc Ánh
GERD- Dr Trần Ngọc Ánh
Gastric emptying studies GERD- Dr Trần Ngọc Ánh
LABORATORY FINDING 6.Acid perfusion test(Berstein test)  Determine if chest pain is caused by acid reflux  A thin tube is passed through on nostril, into the middle of the esophagus. A dilute, acid solution and a physiologic salt solution are alternately poured through the catheter into the esophagus  If the perfusion provokes usual pain and perfusion of the salt produces no pain The patient’s pain is caused by acid reflux GERD- Dr Trần Ngọc Ánh
DIAGNOSIS  Diagnosis: History alone in many cases. A therapeutic trial with a PPI such as Omeprazole 40m bid for 1 week, provides support for the diagnosis of GERD  The diagnostic approach to GERD Documentation of mucosal injury Documentation and quantitation of reflux Definition of the pathophysiology GERD- Dr Trần Ngọc Ánh
COMPLICATIONS Ulcers Barrett’s Stricture esophagus Others GERD- Dr Trần Ngọc Ánh
TREATMENT Life style changes+ Diet Internal medecine Surgery Inhibitory Others Endoscopy drug GERD- Dr Trần Ngọc Ánh
TREATMENT 1.Life style changes A combination of several changes in habit, particularly related eating Elevation of the upper body at night generally is recommend for all patients Reflux also occurs less frequently when patients lie on their left rather than their right sides GERD- Dr Trần Ngọc Ánh
TREATMENT 2.GERD Diet Smaller, earlier evening meals may reduce the amount of reflux These foods should be avoided(↓pressure in the LES) Chocolate Perppemint Alcohol Certainated drinks GERD- Dr Trần Ngọc Ánh
TREATMENT Stop Fatty foods and smoking (↓pressure in the LES) Avoid other food aggravate symptoms: spicy, acid containing food-citrus juices, carbonated beverages, tomato juice One novel approach to the treatment: chewing gum GERD- Dr Trần Ngọc Ánh
TREATMENT: Acid neutralizing/inhibitory drugs Antacids H2antagonists PPI GERD- Dr Trần Ngọc Ánh