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Benign Peptic Stricture or Gastro-Esophageal Reflux Disease (GERD )

Group D Florendo-Gaspar. Benign Peptic Stricture or Gastro-Esophageal Reflux Disease (GERD ). GERD. Symptoms manifests when gastric acid and other gastric contents backflow into the esophagus →burning sensation “heartburn” Almost everyone has occasional heartburn usually after meals.

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Benign Peptic Stricture or Gastro-Esophageal Reflux Disease (GERD )

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  1. Group D Florendo-Gaspar Benign Peptic Stricture orGastro-Esophageal Reflux Disease (GERD)

  2. GERD • Symptoms manifests when gastric acid and other gastric contents backflow into the esophagus →burning sensation “heartburn” • Almost everyone has occasional heartburn usually after meals. • If symptoms occur ≥2 a week for at least 3months, it may be a GERD.  http://www.gerd.com Harrison’s Principles of Internal Medicine, 17th edition

  3. Incidence and Epidemiology • One of the most prevalent GI disorders. • 15% of individuals have heartburn and/or regurgitation at least once a week • 7% - 10% of the population experience symptoms of heartburn daily. • Most cases of heartburn occur because of excess acid reflux • 10% of patients with functional heartburn • Many individuals control symptoms with OTC medications without consulting a medical professional, thus, is likely underreported. http://www.gerd.com Harrison’s Principles of Internal Medicine, 17th edition

  4. Incidence and Epidemiology • Occurs in all age groups • Prevalence increases in people older than 40 y/o • No sexual predilection exists (M=F) • White males are at a greater risk for Barrett esophagus and adenocarcinoma than other populations. 8-15% of patients with GERD → adenocarcinoma • 50% of patients develop esophagitis • GERD is a chronic, but treatable condition, and it is extremely common.  http://www.gerd.com Harrison’s Principles of Internal Medicine, 17th edition

  5. Pathophysiology • The LES plays an important role in digestion. • It may open more often than it should or it may open at the wrong times, allowing stomach acid to back up into the esophagus. • This can be extremely painful. • If this continues for a long time, a portion of the esophagus can become “raw.” This is called erosive esophagitis and it can lead to serious medical problems (scarring, bleeding and ulcers) http://www.gerd.com

  6. Etiologies • Reflux happens when gradient b/w LES and stomach is lost and is usually due to transient or sustained decrease in LES tone. • Transient hypotension of LES is due to: • Vagovagal reflex Harrison’s Principles of Internal Medicine, 17th edition

  7. Etiologies • Sustained hypotension of LES may be due to: • Muscle weakness • Scleroderma-like diseases • Myopathy associated with chronic intestinal pseudoobstruction • Pregnancy • Smoking • Anticholinergic drugs • Smooth-muscle relaxants • Surgical damage to the LES, and esophagitis Harrison’s Principles of Internal Medicine, 17th edition

  8. Other causes of Reflux • Increase in gastric volume • After meals with pyloric obstruction, gastric stasis, acid hypersecretion state • Close proximity of gastric contents to the GEJ • Recumbency, bending down, hiatal hernia • Increase in gastric pressure • Obesity, pregnancy, ascites, tight clothes Harrison’s Principles of Internal Medicine, 17th edition

  9. Complications • Reflux esophagitis • Mild esophagitis • Erosive esophagitis • Peptic stricture Harrison’s Principles of Internal Medicine, 17th edition

  10. Reflux esophagitis • Develops when the damage caused by acid, pepsin, and bile cannot be counteracted by the mucosal defenses Harrison’s Principles of Internal Medicine, 17th edition

  11. Mild esophagitis • Micsoscopic changes • Mucosal infiltration with granulocytes, or small numbers of eosinophils • Hyperplasia of basal cells • Elongation of dermal pegs Harrison’s Principles of Internal Medicine, 17th edition

  12. Erosive esophagitis • Mucosal damage with redness, friability, superficial linear ulcers, exudates • Histology • Polymorphonuclear infiltrates • Mild eosinophilic infiltrates • Granulation tissue . • May heal by intestinal metaplasia →Barrett’s esophagus Harrison’s Principles of Internal Medicine, 17th edition

  13. Peptic stricture • Luminal constriction resulting from fibrosis • 2 types: • Short strictures • 1-3 cm • seen in the distal esophagus, near the GEJ caused by spontaneous reflux • Long/Tubular strictures • Caused by persistent vomiting or by prolonged NGT intubation Harrison’s Principles of Internal Medicine, 17th edition

  14. Clinical Features • Heartburn • Regurgitation of sour material into the mouth

  15. Heartburn • Induced by the contact of refluxed material with the sensitized or ulcerated esophageal mucosa • Angina like/ atypical chest pain

  16. Diagnosis

  17. Barium Swallow • Esophagoscopy • Mucosal biopsies Mucosal injury • Berstein test

  18. Long-term (24–48 h) • esophageal pH recording Reflux

  19. Management decisions Patho- physiologic factors

  20. Treatment Goals of Treatment : • provide symptom relief • heal erosive esophagitis • prevent complications.

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