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GASTROESOPHAGEAL
REFLUX DISEASE (GERD)
OVERVIEW
GERD: It is a persistent gastrointestinal condition, signifies the
backward flow of stomach contents into the esophagus,
characterizing it as a chronic disorder
• It is one of the most commonly diagnosed gastric disorders in
United States and prevalence rate is 20%.
• GERD can occur at any age, however it is more prevalent in
adults.
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(Antunes et al., 2023)
(Maret-Ouda et al., 2020)
Anatomy and Physiology
Lower Esophageal Sphincter (LES):
3-4 cm tonically contracted smooth muscle segment.
Located at the esophagogastric junction (EGJ).
Forms the physiological EGJ barrier with the crucial
diaphragm.
Normal LES Function:
• Maintains a high-pressure zone above intragastric pressures.
• Transient relaxation during meals for the smooth passage of
food into the stomach.
• Ensures unidirectional flow and prevents reflux of gastric
contents.
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•
(Chhabra & Ingole, 2022)
Pathophysiology
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Abnormal LES Function in GERD:
○ Patients with GERD may experience frequent Transient LES Relaxations (TLESRs).
○ Not triggered by swallowing, leading to increased intragastric pressure.
○ Results in reflux of gastric contents into the esophagus
Influencing Factors:
○ LES tone and TLESRs influenced by various factors:
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Alcohol use.
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Smoking.
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Caffeine intake.
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Pregnancy.
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Medications like nitrates and calcium channel blockers.
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Other Contributing Factors may be: hiatal hernia, decreased esophageal clearance, delayed stomach
emptying, and dropped LES pressure
(Chhabra & Ingole, 2022)
(Vijayalaxmi et al., 2020)
Sign and Symptoms
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Heart Burn
Regurgitation
Less frequent Symptoms
Dysphagia
Chest Discomfort
Odynophagia
Burping
Hiccups
Nausea & Vomiting
(Antunes et al., 2023)
(Chhabra & Ingole, 2022)
(Vecteezy, 2024)
Diagnosis of GERD
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a. Proton Pump Inhibitor (PPI) Trial:
○ Presumptive diagnosis in patients with heartburn and regurgitation.
○ Initiate empiric PPI therapy unless there are alarm symptoms.
○ Response to treatment confirms the diagnosis.
○ A meta-analysis questions the accuracy of this diagnostic strategy.
b. Esophagogastroduodenoscopy (EGD):
○ Recommended for patients with typical symptoms and alarm symptoms.
○ Evaluates for complications: erosive esophagitis, Barrett’s esophagus, stricture, and adenocarcinoma.
○ Distal esophageal biopsies not routinely recommended for GERD diagnosis.
○ Evaluation for coronary artery disease in cases of suspected cardiovascular symptoms.
c. Radiographic Studies:
(Chhabra & Ingole, 2022)
○ Barium radiographs can detect esophagitis, strictures, hiatal hernia, and tumors.
○ Limited role in GERD diagnosis; not recommended.
d. Ambulatory Esophageal Reflux Monitoring:
○ Useful in medically refractory GERD and suspected extraesophageal symptoms.
○ Assesses correlation of symptoms with abnormal acid exposure.
○ Utilizes telemetry pH capsule or transnasal catheter.
○ Detects pathological acid exposure, reflux episode frequency, and symptom correlation.
○ Recommended in patients without evidence of erosive esophagitis.
Management of GERD
Medications:
○ First-Line:
○ Proton Pump Inhibitors (PPIs) as initial therapy.
○ Second-Line:
○ Histamine H2 Receptor Antagonists (e.g., ranitidine, famotidine).
○ Prokinetic Medications (e.g., domperidone, metoclopramide) for gastroparesis.
○ Alginate and sucralfate antacids as alternatives in case of adverse reactions.
○ Special Considerations:
○ Pregnant women: Special treatment due to teratogenic effects.
○ Lactating individuals: Histamine H2 receptor antagonists safe for use.
Refractory GERD:
○ Address non-response reasons: Functional heartburn, non-adherence, incorrect diagnosis.
○ Medications: Amitriptyline, tricyclic antidepressants, serotonin reuptake inhibitors for hypersensitivity.
○ Surgical Treatment for complex cases or those resistant to prolonged medication.
○ Three common surgical approaches: Total fundoplication (360°), partial fundoplication (Toupet), assorted
fundoplication.
○ Benefits of video-laparoscopic fundoplication include reduced pain, quick recovery, and minimal lifestyle
modification.
(Chhabra & Ingole, 2022)
(Vecteezy, 2024)
Present Lifestyle Modification
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Dietary changes (avoiding triggers, smaller meals).
Weight loss for those with excess weight.
Elevating the head during sleep
Patient and Family Needs
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Discuss the impact of GERD on patients and their families, including:
○ Disruption of daily life and activities.
○ Emotional considerations.
○ Lifestyle adjustments.
Emphasize the need for a supportive environment.
Conclusion
GERD causes physical symptoms, affecting daily life, emotional states, and requiring
lifestyle changes.
Establishing a supportive environment within the family is crucial for patients to navigate
these challenges successfully.
References
Antunes, C., Aleem, A., & Curtis, S. (2023). Gastroesophageal reflux disease . National Library of Medicine.
https://www.ncbi.nlm.nih.gov/books/NBK441938/
Chhabra, P., & Ingole, N. (2022). Gastroesophageal reflux disease (GERD): Highlighting diagnosis,
treatment, and lifestyle changes. Cureus. https://pubmed.ncbi.nlm.nih.gov/36185857
Diagnosis royalty-free images, stock photos & Pictures. Shutterstock. (2024).
https://www.shutterstock.com/search/diagnosis
Download free vectors, clipart graphics, Vector Art & design templates. Vecteezy. (2024).
https://www.vecteezy.com/free-vector/taking-medicine
Maret- Ouda, J., Markar, S., & Lagergren. (2020). Gastroesophageal reflux disease: A Review. JAMA.
https://pubmed.ncbi.nlm.nih.gov/33351048/
Vijayalaxmi, T., Maunki, N., & Nagavamashidhar. (2019). Gastro esophageal reflux disease. PharmaTutor.
https://www.pharmatutor.org/articles/gastro-esophageal-reflux-disease
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