GERD

Question 1

Epidemiology of GERD

Answer 1

common, occurring in 10-20% of adults. M>F. It also occurs frequently in infants, typically beginning at birth.

Question 2

Aetiology of GERD

Answer 2

excessive retrograde movement of acid - damages lower oesophagus (HCL,bile)

loss of LES (lower oesophageal sphincter) tone or from transient relaxations
Transient LES relaxations are triggered by gastric distention or subthreshold pharyngeal stimulation.

Factors contributing to reflux include weight gain, fatty foods, caffeinated or carbonated beverages, alcohol, tobacco smoking, and drugs.

Drugs that lower LES pressure include anticholinergics, antihistamines, tricyclic antidepressants, Ca blockers, progesterone, nitrates.

Question 3

Pathogenesis of Gerd

Answer 3

lower esophageal sphincter (LES) incompetence
delayed gastric emptying
hiatus hernia

Question 4

Natural History

Answer 4

can lead to oesophageal cancer!

Question 5

Manifestations

Answer 5

worse after eating/laying flat.

Question 6

Symptoms

Answer 6

heartburn, with or without regurgitation of gastric contents into the mouth.

Dysphagia, chest pain. (non cardiac)

coughing/wheezing/hoarseness/sore throat

Infants present with vomiting, irritability, anorexia,

Both adults and infants with chronic aspiration

Question 7

Signs

Answer 7

teeth discolouration, changed skin in throat.

Question 8

Complications

Answer 8

esophagitis, peptic esophageal ulcer, esophageal stricture, Barrett esophagus, and esophageal adenocarcinoma, bleeding, dental enamel erosions, asthma

Question 9

Prognosis

Answer 9

Good with medications, bad if barretts oesophagus develops