Diseases Of The Esophagus .GERD

Question 1

Definition of Gastro-oesophageal reflux disease

Answer 1

It’s a chronic oesophageal disease characterised by inflammation and reflux of acid content of stoa,ch resulting in the dysfunction of the esophagus

Question 2

Function of the oesophagus

Answer 2

Transportation (food)
Prevention of black flow or reflux
Has 2 sphincter

Question 3

Layers of oesophagus

Answer 3

Mucosa
Submucosa
Muscularis propralis
Adventitia

Question 4

Classifications

Answer 4

Endoscopic
And morphological

Question 5

Classification by SVARI by severity

Answer 5

Degree 1-single or isolated erosive lesions affecting only one longitudinal fold affecting lesions 10% of circumference of esophagus

Degree 2- multiple erosive lesions non-circumference folds affecting 10-15% of circumference of esophagus

Degree3- circumference erosive lesion affecting more than 50% of

Degree 4- multiple lesion total erosion Barrett’s esophagus
( changing of the stratified squamous epithelium to simple columnar) metaplasia

Question 6

Classification by degree Los Angeles

Answer 6

Degree A- one or more mucosal lesions no longer than 5mm within one fold

Degree B- one or more mucosal lesions more than 5mm within one or more fold

Degree C-one or more continuous lesions within two or more lesions folds less than 70% circumference

Degree D-more than 75% of circumference

Question 7

Mechanic af actionof GERD/pathogenesis

Answer 7

Increase intrabdominalpressure

Relaxationof lower esophagus sphincter

Question 8

Risk factors

Answer 8

IncreaseAbdominalpressure
Pregnancy
Obesity
Over eating
Delayed evacuation of meal due to
Hiatal hernia
Bloating
Position of body aftermeal(horizontal)
Carbonated drinks

Risk factors for relaxation
Of LES
Alcohol
Meal- chocolate, mint, coffee
Smoking
Medication-nitrates,Valium,myorelaxants
Achalasia-

Question 9

Clinical symptoms (esophageal syndrome)

Answer 9

Heartburn recurrent
Dysphagia -difficult swallowing
Regurgitation
Odynophagia -pain when swallowing
Chest pain

Question 10

Clinical symptoms (extra esophageal syndrome)

Answer 10

Chronic cough
Hoarseness/voice changes
Otitis
Sinusitis
sore/burning throat
Asthma
pneumonia
Sleep apnea
Dental erosion
Chronic bronchitis
Laryngitis
Angina
Arrhythmia

Question 11

Diagnosis

Answer 11

Endoscopy
Barium X-ray studies (perforation,hernia )
Oesophageal manometry-
PH metry-

Question 12

Complications

Answer 12

Ulcer
Cancer
Barretts esophagus
Bleeding
Stricture of E

Question 13

Treatment

Answer 13

Lifestyle Modifications
• Do not eat before sleeping
• Avoid recumbency for 3 h postprandially
• Stop smoking
• Decrease fat intake
• Avoid certain refluxogenic foods
• Avoid large meals
• Weight loss
• Avoid medications that can potentiate symptoms
• Positional changes during the sleep period is
recommended
• Head of bed elevation

Question 14

Treatment

Answer 14

H2 antagonists
• Pepcid (famotidine)
• Axid (nizatidine)
• Tagamet (cimetidine)
• Zantac (ranitidine)
PPIs can bind only to proton pumps that are actively secreting
acid
• Prilosec (omeprazole)
• Protonix (pantoprazole)
• Prevacid (lansoprazole)
• Aciphex (rabeprazole)
• Nexium (esomeprazole)
Antacids are used exclusively for on-demand symptom relief
• Aluminium hydroxide

Prokinetic prevent regurgitation-
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