Gastroesophageal reflux disease (GERD)

Posted by e-Medical PPT
Gastroesophageal reflux disease (GERD) is chronic symptoms or mucosal damage caused by stomach acid coming up from the stomach into the esophagus.A typical symptom is heartburn.GERD is usually caused by changes in the barrier between the stomach and the esophagus, including abnormal relaxation of the lower esophageal sphincter, which normally holds the top of the stomach closed; impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. These changes may be permanent or temporary ("transient").
The most-common symptoms of GERD are:
    * Heartburn
    * Regurgitation
    * Trouble swallowing (dysphagia)
    * Pain with swallowing (odynophagia)
    * Excessive salivation (also known as water brash)
GERD sometimes causes injury of the esophagus. These injuries may include:
    * Reflux esophagitis—necrosis of esophageal epithelium causing ulcers near the junction of the stomach and esophagus.
    * Esophageal strictures—the persistent narrowing of the esophagus caused by reflux-induced inflammation.
    * Barrett's esophagus— intestinal metaplasia (changes of the epithelial cells from squamous to intestinal columnar epithelium) of the distal esophagus.
    * Esophageal adenocarcinoma—a rare form of cancer.
A detailed historical knowledge is vital for an accurate diagnosis. Useful investigations may include ambulatory Esophageal pH Monitoring, barium swallow X-rays, esophageal manometry, and Esophagogastroduodenoscopy (EGD).The current gold standard for diagnosis of GERD is esophageal pH monitoring. It is the most objective test to diagnose the reflux disease and it also allows to monitor GERD patients in regards of their response to medical or surgical treatment.

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