Recent Modalities in the Management of Gastro-0esophageal Reflux Disease
Hossam Sobhy Abdelraheem;
Abstract
Gastrooesophageal reflux disease (GERD) is the commonest upper digestive disorder. It affects a large group of patients and has a negative impact on quality of life. In addition this disorder is associated with considerable long term morbidity and mortality.
The esophagus is a flattened muscular tube of 18 to 26 cm from the upper sphincter to the lower sphincter. Between swallows the esophagus is collapsed but the lumen can distend to approximately 2 cm in the anterior-posterior dimension and up to 3cm laterally to accommodate a swallowed bolus.
Gastroesophageal reflux is a normal physiologic event, but excessive exposure of esophageal or supraesophageal epithelium to gastric refluxate resulting in either mucosal injury or related symptoms is the fundamental abnormality in GERD.
Although all normal individuals experience some sort of physiological gastroesophageal reflux, a highly efficient barrier exists between the stomach and the esophagus. From the esophageal side, esophageal clearance is promoted by peristalsis and salivary production.
Hiatal hernias are present in more than 90% of patients with severe erosive esophagitis, especially if complications are present, such as esophageal stricture or Barrett’s esophagus.
GERD is diagnosed or at least suspected is by its characteristic symptom, heartburn. To confirm the diagnosis, physicians often treat patients with medications to suppress the production of acid by the stomach. If the heartburn then is diminished to a large extent, the diagnosis of GERD is considered. This approach is commonly called a therapeutic trial.
There are problems with this approach primarily because it does not include diagnostic tests. For instance, patients who have conditions that can mimic GERD, specifically duodenal or gastric ulcers, also can actually respond to such treatment. In this situation, if the physician assumes that the problem is GERD, he or she will not look for the cause of the ulcer disease.
It is essential to be aware of the alarm symptoms that may require immediate investigation. These include: dysphagia, odynophagia (painful swallowing) haematemesis, and weight loss.
The complications of gastroesophageal reflux disease (GERD) Include esophagitis, ulcers, strictures, Barrett’s
The esophagus is a flattened muscular tube of 18 to 26 cm from the upper sphincter to the lower sphincter. Between swallows the esophagus is collapsed but the lumen can distend to approximately 2 cm in the anterior-posterior dimension and up to 3cm laterally to accommodate a swallowed bolus.
Gastroesophageal reflux is a normal physiologic event, but excessive exposure of esophageal or supraesophageal epithelium to gastric refluxate resulting in either mucosal injury or related symptoms is the fundamental abnormality in GERD.
Although all normal individuals experience some sort of physiological gastroesophageal reflux, a highly efficient barrier exists between the stomach and the esophagus. From the esophageal side, esophageal clearance is promoted by peristalsis and salivary production.
Hiatal hernias are present in more than 90% of patients with severe erosive esophagitis, especially if complications are present, such as esophageal stricture or Barrett’s esophagus.
GERD is diagnosed or at least suspected is by its characteristic symptom, heartburn. To confirm the diagnosis, physicians often treat patients with medications to suppress the production of acid by the stomach. If the heartburn then is diminished to a large extent, the diagnosis of GERD is considered. This approach is commonly called a therapeutic trial.
There are problems with this approach primarily because it does not include diagnostic tests. For instance, patients who have conditions that can mimic GERD, specifically duodenal or gastric ulcers, also can actually respond to such treatment. In this situation, if the physician assumes that the problem is GERD, he or she will not look for the cause of the ulcer disease.
It is essential to be aware of the alarm symptoms that may require immediate investigation. These include: dysphagia, odynophagia (painful swallowing) haematemesis, and weight loss.
The complications of gastroesophageal reflux disease (GERD) Include esophagitis, ulcers, strictures, Barrett’s
Other data
| Title | Recent Modalities in the Management of Gastro-0esophageal Reflux Disease | Other Titles | الاتجاهات الحديثة في علاج مرض ارتجاع المرئ | Authors | Hossam Sobhy Abdelraheem | Issue Date | 2014 |
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