Gastroesophageal Reflux

Question 1

Definition, classification, etiology, risk factors, clinics

Answer 1

This is the recurrent regurgitation of gastric contents into the esophagus
Etiology
Stress, diet, decreased tone of lower esophageal sphincter muscles, delayed gastric emptying, increased intrabdominal pressure.
Risk factors
Smoking, obesity, alcoholism, drugs, pregnancy
Clinics- heartburn, benching, sour or bitter vomiting, chest pain, increased salivation, dysphagia, hiccups
Classification
(According to unified clinical and statistical classification of diseases of the digestive system (HCD of Ukraine, 2004)
-Endoscopic “-“ GERD (without esophagitis)
-Endoscopic “+” GERD (with esophagitis)
Clinical forms of GERD
Nonerosive GERD (is defined as those who have typical reflux symptoms without evidence of erosive changes in their lower esophageal mucosa; observed in approximately 60% of patients with GERD);
Erosive GERD (erosive changes of esophageal epithelium in varying degree, found in 37% of patients);
Grade A - one or more mucosal breaks < 5 mm in maximal length
Grade B - one or more mucosal breaks > 5mm, but without continuity across mucosal folds
Grade C - mucosal breaks continuous between > 2 mucosal folds, but involving less than 75% of the esophageal circumference
Grade D - mucosal breaks involving more than 75% of esophageal circumference

Question 2

Diagnosis, treatment and complications

Answer 2

Diagnosis 
pH-metry (one-stage and daily pH monitoring)
Normal esophageal pH - 5,5-7,0.
Total time of lowering intraesophageal
pH <4.0 during the day is> 4 hours in
patients with GERD.

2.Internally esophageal manometry
(is a test to assess motor function of the Upper Esophageal Sphincter 3.Endoscopy with analysis of biopsy specimens obtained during endoscopy for + or -.

4.PPI(proton pump inhibitor test 
PPI in the standard dose
duration of 7-14 days
positive with the disappearance or reduction of symptoms of GERD
if symptoms disappear(GERD )

Treatment 
Omeprazole 20mg twice daily
Motility agents- metoclopramide 
Antacids, Famotidine
Complications 
Barrett’s esophagus, strictures, bleeding