Transcript Gastroesophageal Reflux Disease

Gastroesophageal Reflux
Disease (GERD)
* Definition:
inflammation of the lower part of the
esophagus due to abnormal reflux of gastric contents into
the esophagus
– Often chronic and relapsing
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• GERD is due to weakness of the lower
esophageal sphincter (LES) leading to reflux of
the acidic gastric content to the lower part of
the esophagus.
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* Risk factors:
- Obesity
- Sliding Hiatal hernia
- Pregnancy
- Smoking
- Delayed stomach emptying
- Connective tissue disorders, such as scleroderma
- Alcoholism.
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* Clinical Manifestations:
1. Heartburn: retrosternal burning discomfort.
2. Regurgitation: effortless return of gastric
contents into the pharynx without nausea, or
abdominal contractions. To be differentiated
from vomiting.
3. Dysphagia: difficulty in swallowing
4. Extra-esophageal manifestations: laryngitis,
chronic cough
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* Morphological features of GERD:
* Grossly: the lower part of the esophagus is red,
and may shows erosions.
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* Microscopically:
1. Inflammatory cellular infiltrate in the
squamous epithelium including neutrophils,
esinophils and lymphocytes.
2. Basal cell hyperplasia.
3. Acute inflammation of the sub epithelium
(lamina propria)
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* Investigations:
Esophagogastrodudenoscopy
• Indications (with biopsy if needed):
– In patients with alarm signs/symptoms
– Those who fail a medication trial
– Those who require long-term treatment.
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* Complications of GERD:
• Erosive esophagitis
• Stricture of esophagus due to healing by
fibrosis.
• Barrett’s esophagus
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• Erosive esophagitis:
– Responsible for 40-60% of GERD symptoms
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• Esophageal
stricture
– Result of healing
of erosive
esophagitis
– May need
dilatation
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• Barrett’s Esophagus:
– Transformation of the stratified squamous
epithelium of the lower end of the esophagus
into intestinal epithelium (glandular
metaplasia).
– The clinical significance of Barrett’s Esophagus
is that it is associated with the development of
dysplasia and subsequently adenocarcinoma.
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References:
Robbins and Cotran’s: Pathologic Basis of Disease. Seventh edition.
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