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GERD Reflux Oesophagitis.pptx

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GERD Reflux Oesophagitis.pptx

  1. 1. Tips on using my ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. 7. See notes for bibliography.
  2. 2. Learning Objectives
  3. 3. Learning Objectives 1. Introduction & History 2. Relevant Anatomy, Physiology 3. Aetiology 4. Pathophysiology 5. Pathology 6. Classification 7. Clinical Features 8. Investigations 9. Management 10. Prevention 11. Guidelines 12. Take home messages
  4. 4. Introduction & History. •
  5. 5. Introduction • Reflux esophagitis is an esophageal mucosal injury that occurs secondary to retrograde flux of gastric contents into the esophagus. • Typically, the reflux disease involves the distal 8-10 cm of the esophagus and the gastroesophageal junction. • Definition:chronic symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus
  6. 6. Aetiology
  7. 7. Aetiology • Idiopathic • Congenital/ Genetic • Nutritional Deficiency/excess • Traumatic • Infections /Infestation • Autoimmune • Neoplastic (Benign/Malignant) • Degenerative / lifestyle • Iatrogenic • Psychosomatic • Poisoning/ Toxins/ Drug induced
  8. 8. Etiology • Idiopathic • Congenital • Traumatic • Infections /Infestation • Autoimmune • Neoplastic (Benign/Malignant) • Degenerative
  9. 9. Etiology • Reflux of gastric contents into the esophagus due to weak lower esophageal sphincter (LES) function, • Impaired esophageal clearance – Esophageal dysmotility – Presence of hiatal hernia, – Poor gastric emptying
  10. 10. Etiology • Obesity • Smoking • Alcohol, • High dietary fat • Drugs • Microbiome alteration The protective role of Helicobacter pylori infection in the development of GERD remains controversials
  11. 11. Pathophysiology
  12. 12. Pathophysiology Mechanism of LES –Intrinsic distal esophageal muscles – tonically contracted –Muscular Sling fibers of the gastric cardia –Diaphragmatic crura –Transmitted pressure of the abdominal cavity
  13. 13. Pathophysiology • Pepsin” in the reflux contents • Strong acid (pH < 2), however, can cause mucosal damage independent of the presence of pepsin. • The presence of bile in reflux contents is increasingly thought to contribute to reflux disease in a subset of cases, as observed in patients on proton pump inhibitor (PPI) therapy.
  14. 14. Clinical Features •
  15. 15. Clinical Features • Demography • Symptoms • Signs • Prognosis • Complications
  16. 16. Demography
  17. 17. Demography • 25-40% of healthy adult Americans experienced symptomatic GERD at least once a month. • white individuals have higher prevalence of severe grades of esophagitis • no sex predilection. • incidence of GERD increased in the autumn and winter • Incidence of reflux esophagitis has doubled over a period of 10 years.
  18. 18. Symptoms • .
  19. 19. Symptoms Esophageal and Extraesophageal • Esophageal – Heartburn – acid dyspepsia – Regurgitation – Chest pain. • Exraesophageal symptoms cough, asthma, throat pain, aspiration pneumonia, globus sensation, and hoarseness due to pharyngitis, laryngitis, or sinus problems.
  20. 20. Symptoms • Exraesophageal symptoms – cough – Asthma – throat pain – aspiration pneumonia, – globus sensation – hoarseness due to pharyngitis, laryngitis, or sinus problems.
  21. 21. Alarming Signs & Symptoms • Dysphagia • Early satiety • GI bleeding • Odynophagia • Vomiting • Weight loss • Iron deficiency anemia
  22. 22. Complications
  23. 23. Complications • Barrett esophagus • Dysplasia • Malignancy
  24. 24. Investigations • Laboratory Studies – Routine – Special • Imaging Studies • Tissue diagnosis – Cytology • FNAC – Histology – Germ line Testing and Molecular Analysis • Diagnostic Laparotomy.
  25. 25. Diagnostic Studies Imaging Studies • X-Ray • USG • CT • Angiography • MRI • Endoscopy • Nuclear scan
  26. 26. Diagnostic Studies Imaging Studies • X-Ray –Barium swallow • USG • CT • Angiography • MRI • Endoscopy • Nuclear scan
  27. 27. Differential diagnosis • .
  28. 28. Diagnostic Studies • Esophagogastroduodenoscopy (EGD) (or, upper gastrointestinal [GI] endoscopy) with biopsy, • 24-hour pH study, • manometry, • barium contrast study, • Gastric emptying study.
  29. 29. Diagnostic Studies • According to the diagnostic guidelines established by American College of Gastroenterology (ACG) for GERD, if a patient’s history is typical for uncomplicated GERD, an initial trial of empirical therapy is appropriate, without further investigation.
  30. 30. Diagnostic Studies • Endoscopy and biopsy are recommended by the ACG to identify complications of GERD, such as Barrett esophagus, dysplasia, or malignancy • Based on the presence or absence of mucosal changes seen on endoscopy, GERD is classified into 2 groups: nonerosive reflux disease (NERD) and erosive esophagitis
  31. 31. Diagnostic Studies • The endoscopic findings in gastroesophageal reflux disease (GERD) range from normal esophageal mucosa to erosions and ulcerations
  32. 32. Diagnostic Studies Microscopy • squamous (basal) cell hyperplasia, elongation of vascular papillae, presence of intraepithelial inflammatory cells, dilated intercellular spaces (intercellular edema), ballooning degeneration of squamous cells (due to accumulation of intracellular plasma proteins), vascular lakes (dilated small blood vessels in superficial lamina propria/vascular papillae), acanthosis, mucosal erosions and ulcerations
  33. 33. Management •
  34. 34. Management • The treatment is based on • 1 lifestyle modification • 2 control of gastric acid secretion – through medical therapy with • antacids • PPIs – surgical treatment with corrective antireflux surgery
  35. 35. Lifestyle Modifications • Losing weight (if overweight) • Avoiding alcohol, chocolate, citrus juice, and tomato-based products peppermint, coffee, and possibly the onion • Avoiding large meals • Waiting 3 hours after a meal before lying down • Elevating the head of the bed by 8 inches
  36. 36. Minimally invasive Therapy Laparoscopic fundoplication • Complete mobilization of the fundus of the stomach with division of the short gastric vessels • Reduction of the hiatal hernia • Narrowing of the esophageal hiatus • Creation of a 360° fundoplication over a large intraesophageal dilator (Nissen fundoplication)
  37. 37. Operative Therapy
  38. 38. Operative Therapy • Indications for fundoplication include the following: • Patients with symptoms that are not completely controlled by PPI therapy • Barrett esophagus • extraesophageal manifestations Young patients • Poor patient compliance with regard to medications • Postmenopausal women with osteoporosis • Patients with cardiac conduction defects
  39. 39. Get this ppt in mobile 1. Download Microsoft PowerPoint from play store. 2. Open Google assistant 3. Open Google lens. 4. Scan qr code from next slide.
  40. 40. Get this ppt in mobile
  41. 41. Get my ppt collection • https://www.slideshare.net/drpradeeppande/ edit_my_uploads • https://www.dropbox.com/sh/x600md3cvj8 5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl =0 • https://www.facebook.com/doctorpradeeppa nde/?ref=pages_you_manage

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