GERD

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بسم الله الرحمن الرحيم قالوا سبحانك لا علم لنا إلا ما علمتنا إنك أنت العليم الحكيم صدق الله العظيم البقرة : من الآي ة 32

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GERD By Dr. Ayman El Deeb

GERD : 

GERD Occurs when stomach acid rise or reflux into the esophagus causing symptoms of heart burn or a bitter taste in the throat.

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The regurgitated fluid content contains acid pepcin and may contain bile ,and it can cause Inflammation of the esophageal mucosa (esophagitis)

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Most people experience reflux symptoms at some points of their lives without significant impact but when reflux occurs regularly it can disturb daily routine and can cause a chronic respiratory disease.

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The disease can affect people of all ages, children usually experience GERD in their early months of life with its peak in the 4th month and it usually decline and disappear by the 2nd year.

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GERD is caused by the dysfunction of (LES), the lower esophageal sphincter. It is possible for the only manifestation of GERD to be chronic respiratory disease such as Asthma or chronic sinusitis.

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Dysfunction Of LES

Causes of GERD:: 

Causes of GERD: Obesity, Hiatus hernia in 30% of patients with GERD, pregnancy, smoking alcohol & scleroderma certain drugs may worsen the GERD (Anti cholinergics beta blockers, theophylline sedatives).

Hiatus hernia: 

Hiatus hernia Most of the stomach Appear in the Thoracic cavity

Symptoms of GERD : 

Symptoms of GERD Chronic cough for many months or years with normal x ray. Wheezy respiration or Asthma . Aspiration of gastric acid or content and chest infection and choking Vocal cord dysfunction and chronic laryngeal inflammation leading to chronic laryngitis

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Hoarseness of voice. Dental erosions. Chronic nasal congestion, chronic sinusitis or ear infection. Heart burns and Non cardiac chest pains. Many of the patients lack the symptoms of heart burn which lead to misdiagnosis of the disease.

Complications : 

Complications Asthma Most of asthmatic patients complain of heart burn and as many as 80% of patients diagnosed with asthma suffer from GERD. GERD may trigger Asthmatic attacks or asthma like symptoms via indirect stimulation of the vagus Nerve .

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chronic cough may be induced by the rise of acid in the lower end of the esophagus as a reflex via the Vagus. Many patients with refractory Asthma improve with acid suppression medications .

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Barette esophagus : The condition is precancerous when change of the mucous lining of the esophagus from stratified squamous epithelium to metaplastic columnar cells . The patient should be kept under close medical observation, with endoscopy every 6 months .

Barette esophagus: 

Barette esophagus

Squamous metaplasia : 

Squamous metaplasia

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Esophageal ulcer and bleeding Stricture

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Non cardiac chest pains This usually needs many investigations to rule out any cardiac cause for the pain, not only that but some patients experience some dropped beats after meals which make the condition difficult to diagnose .

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Chocking The patients with GERD usually get chocking during sleep ,which increase or decrease with the change of the position of the patient. The patient is chocked with the acidic gastric contents of the stomach , and we have seen some of them with chest infection , in a case report one patient had two lung abscesses because of that.

Chronic cough & hoarseness : 

Chronic cough & hoarseness Cough is chronic when it is persistent and lasting 8 weeks or longer , the cough is not a disease in it self but a symptom of an underlying condition , the main three causes of chronic cough with normal cxr are post nasal drip , Asthma and GERD .

How do you diagnose GERD: 

How do you diagnose GERD From the history of the patient, it is easy to suspect GERD , usually they have sore throat, congested throat on examination, heart burns and epigastric pains on examination, occasionally wheezy respiration could be heard.

Investigations for GERD : 

Investigations for GERD Esophageal manometry to measure the pressure of the LES Esophageal PH monitoring Barium Swallow Endoscopy

PH monitoring: 

PH monitoring

Treatment of GERD : 

Treatment of GERD Change of life style, The patient should take a small meals, many in numbers and small in amount, to stop the spicy food citrous fruits, caffinated drinks, chocolates, peppermint and fatty meals,the patient should raise the head of the bed 15 cm. and don't go to bed immediately after meals.

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Antacids like Mallox, they give immediate relief but they don't heal the esophageal ulcers, also some of them can cause diarrhea or constipation. H2 receptor blockers

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PPI they block the acid production and help in the heal of esophageal ulcers . The use of these drugs for a long time may lead to decrease in bone density and increase the chance of bone fracture . Also PPI may interfere with the clopidogrel , and decrease its effectiveness, the only PPI that does not affect it is Pantoprazol. Prokinetic drugs that help in rapid emptying of the stomach

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Surgical treatment, Funduplication, The upper part of the stomach is wrapped around the lower end of the esophagus to enforce the LES .

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The respiratory symptoms should be treated hand in hand with the treatment of GERD

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Thank you