- •Ihor Vynnychenko
- •Definition of GERD
- •Physiologic
- •GERD occurs in all ages but, most common in those older than 40
- •Primary barrier to gastro esophageal reflux is the lower esophageal sphincter
- •Drugs that reduce LES tone include calcium channel antagonists (e.g., nifedipine, verapamil, diltiazem),
- •2)DISRUPTION OF ANATOMICAL BARRIERS
- •4)MUCOSAL RESISTANCE
- •Erosive esophagitis
- •Esophageal stricture
- •Barrett’s Esophagus
- •Barrett’s Esophagus
- •3 CLASSES OF SYMPTOMS
- •Atypical symptoms
- •ALARM SIGNS/SYMPTOMS
- •If classic/typical symptoms like heartburn and regurgitation exist in the absence of “alarm
- •Endoscopy (with biopsy if needed)
- •24-hour pH monitoring
- •H2RA taken
- •Goals of therapy
- •Lifestyle modifications
- •Antacids
- •Histamine H2-Receptor Antagonists
- •AGENT
- •AGENT
- •H2RAs vs PPIs
- •Antireflux surgery
- •Postsurgery
- •Endoscopic treatment
- •Definition of GERD
- •?QUESTIONS?
Antireflux surgery
Failed medical management
Patient preference
GERD complications
Medical complications attributable to a large hiatal hernia
Atypical symptoms with reflux documented on 24-hour pH monitoring
Postsurgery
10% have solid food dysphagia
2-3% have permanent symptoms
7-10% have gas, bloating, diarrhea, nausea, early satiety
Within 3-5 years 52% of patients back on antireflux medications
Endoscopic treatment
Relatively new
No definite indications
Select well-informed patients with well- documented GERD responsive to PPI therapy may benefit
Three categories
Radiofrequency application to increase LES reflux barrier
Endoscopic sewing devices
Injection of a nonresorbable polymer into LES area
Definition of GERD
Epidemiology of GERD
Pathophysiology of GERD
Clinical Manisfestations
Diagnostic Evaluation
Treatment
Complications