GERD

GERD

Anatomy of esophagus
1. Histology
3. Blood supply
  1. Arteries
    1. Cervical part by Inferior thyroid
    2. Thoracic part by Descending aorta
    3. Abdominal part by Left gastric and Left Inferior Phrenic arteries
  2. Veins
    1. Abdominal: Left gastric of potral system + inf. venacava and inf. hemiazygos
    2. Cervical part- Inferior thyroid vein
    3. Thoracic part- Azygos and hemiazygos
4. Innervation
  1. Parasympathetic
    1. vagus and recurrent laryngeal nerves
  2. Sympathetic
    1. T4-T6
Phases of swallowing
Causes of dysphagia
1. Achalasia. Diffuse spasm. Esophageal stricture. Esophageal tumors. Foreign bodies. Esophageal ring. Gastroesophageal reflux disease (GERD). Eosinophilic esophagitis. Radiation therapy.
Causes of Chest discomfort
1. Myocardial infarction Angina , Pleuritis Pneumonia , rib fracture Shingles, Peptic ulcers, GERD
Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the esophagus. This acid reflux can irritate the lining of the esophagus
Pathophysiology
1. Abnormal lower esophageal sphincter
  2. Causes
    1. Hypotensive LES
    2. Inadequate response to increased intraabdominal pressure
    3. TLESR (transient lower esophageal sphincter relaxation)
2. Sliding hiatal hernia
Complications
1. Ulcers
2. Strictures
3. Respiratory problems
4. Barrett's esophagus
  1. At least 1 cm of metaplastic columnar epithelium that replaces the stratified squamous epithelium normally lining the distal esophagus
Signs & Symptoms
1. Heartburn , Dysphagia , Belching , Bad Breath , Erosion of the enamel of the teeth , Regurgitation , Cough and Asthma
Investigations
1. upper GI series
2. upper endoscopy
3. 24-hour esophageal pH study
4. esophageal impedance testing
Predisposing factors
1. Alcohol, Chocolate, Obesity, Pregnancy, Hiatal hernia
Pharmacological management
1. Antacids
2. Antisecretory drugs
  1. H2-receptor antagonists (cimetidine)
  2. Acid/Proton-pump inhibitors (omeprazole)
  3. Muscarinic M1 receptor antagonists
  4. Prostaglandin analogues
3. Cytoprotective drugs (colloidal bismuth, sucralfate)
4. both a cyto-protective and anti-secretory action (misoprostol)
Surgical Treatment
1. Fundoplication
2. Transoral Incisionless Fundoplication
3. LINX Reflux Management System

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