Princess Celmea S. Aspuria

Gastroesophageal reflux disease (GERD), gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease is chronic symptoms or mucosal damage caused by stomach acid coming up from the stomach into the esophagus

CLINICAL MANIFESTATIONS• Pyrosis (burning sensation in the esophagus)• Dyspepsia (indigestion)• Regurgitation• Dysphagia or odynophagia (pain on swallowing)• Hypersalivation• Esophagitis

ASSESSMENT AND DIAGNOSTIC FINDINGS• Endoscopy or barium swallow : used to evaluate

damage to the esophageal mucosa• Ambulatory 12 to 36-hour esophageal pH monitoring :

used to evaluate the degree of acid reflux• Bilirubin monitoring (Bilitec) : used to measure bile

reflux patterns Exposure to bile can cause mucosal damage

GERD is caused by a failure of the cardia. In healthy patients, the "Angle of His"—the angle at which the esophagus enters the stomach—creates a valve that prevents duodenal bile, enzymes, and stomach acid from traveling back into the esophagus where they can cause burning and inflammation of sensitive esophageal tissue.

Factors that can contribute to GERD:• Hiatal hernia, which increases the likelihood of GERD

due to mechanical and motility factors.• Obesity: increasing body mass index is associated with

more severe GERD• Zollinger-Ellison syndrome, which can be present with

increased gastric acidity due to gastrin production• Hypercalcemia, which can increase gastrin production,

leading to increased acidity

• Scleroderma and systemic sclerosis, which can feature esophageal dysmotility

• Visceroptosis or Glénard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.

MANAGEMENT• Teach patient to avoid situations that decrease lower

esophageal sphincter or cause esophageal irritation• Instruct patient to eat a low fat diet, avoid caffeine,

tobacco, beer, milk , foods containing peppermint or spearmint, and carbonated beverages

• Avoid eating or drinking 2 hours before bedtime• Maintain normal body weight• Avoid tight-fitting clothes

MANAGEMENT• Elevate head of the bed 6-8inches and elevate upper

body on pillows• If reflux persists, antacids or H2 receptor antagonists

such as famotidine (Pepcid), nizatidine (Axid), or ranitidine (Zantac), may be prescribed

• Proton pump inhibitors (medications that decrease the release of gastric acid, such as lansoprazole (Prevacid) or rabeprazole (Aciphex) may be used

MANAGEMENT• The patient may receive prokinetic agents, which

accelerate gastric emptying. These agents include bethanechol (Urecholine), domperidone (Motilium), and metoclopramide (Reglan). Metoclopramide has central nervous system complications

with long-term use.

MANAGEMENT• If medical management is unsuccessful, surgical

intervention may be necessary. Surgical management involves a fundoplication (wrapping of a portion of the gastric fundus around the sphincter area of the esophagus). Fundoplication may be performed by laparoscopy.