GERD

GERD

1. Anatomy of esophagus

   • Histology
   • Blood supply
     • Arteries
       • Cervical part by Inferior thyroid
       • Thoracic part by Descending aorta
       • Abdominal part by Left gastric and Left Inferior Phrenic arteries
     • Veins
       • Abdominal: Left gastric of potral system + inf. venacava and inf. hemiazygos
       • Cervical part- Inferior thyroid vein
       • Thoracic part- Azygos and hemiazygos
   • Innervation
     • Parasympathetic
       • vagus and recurrent laryngeal nerves
     • Sympathetic
       • T4-T6

2. Phases of swallowing

3. Causes of dysphagia

   • Achalasia.  Diffuse spasm. Esophageal stricture.  Esophageal tumors.  Foreign bodies.  Esophageal ring.  Gastroesophageal reflux disease (GERD).  Eosinophilic esophagitis.  Radiation therapy.

4. Causes of Chest discomfort

   • Myocardial infarction Angina , Pleuritis Pneumonia , rib fracture Shingles, Peptic ulcers, GERD

5. Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the esophagus. This acid reflux can irritate the lining of the esophagus

6. Pathophysiology

   • Abnormal lower esophageal sphincter
     • Causes
       • Hypotensive LES
       • Inadequate response to increased intraabdominal pressure
       • TLESR (transient lower esophageal sphincter relaxation)
   • Sliding hiatal hernia

7. Complications

   • Ulcers
   • Strictures
   • Respiratory problems
   • Barrett's esophagus
     • At least 1 cm of metaplastic columnar epithelium that replaces the stratified squamous epithelium normally lining the distal esophagus

8. Signs & Symptoms

   • Heartburn , Dysphagia , Belching , Bad Breath , Erosion of the enamel of the teeth , Regurgitation , Cough and Asthma

9. Investigations

   • upper GI series
   • upper endoscopy
   • 24-hour esophageal pH study
   • esophageal impedance testing

10. Predisposing factors

    • Alcohol, Chocolate, Obesity, Pregnancy, Hiatal hernia

11. Pharmacological management

    • Antacids
    • Antisecretory drugs
      • H2-receptor antagonists (cimetidine)
      • Acid/Proton-pump inhibitors (omeprazole)
      • Muscarinic M1 receptor antagonists
      • Prostaglandin analogues
    • Cytoprotective drugs (colloidal bismuth, sucralfate)
    • both a cyto-protective and anti-secretory action (misoprostol)

12. Surgical Treatment

    • Fundoplication
    • Transoral Incisionless Fundoplication
    • LINX Reflux Management System

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