gastroesophageal reflux disease1

7/17/2019 Gastroesophageal Reflux Disease1

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GASTROESOPHAGEAL RE

DISEASE (GERD)

Centre of Gastroentero-Hepatology, Wahidin Sudirohusodo

Internal Medicine, Faculty of Medicine, Hasanuddin Univer

“UGI Disorders” Lecture in GEH Syste! F"UH



#e$nition

“ A condition which develops when the refluxstomach contents causes troublesome sym

and/or complications." (Montreal 2006)

"troublesome" is that symptoms adversely a

patient's quality of life he definition of !#$ can% alternatively% b

based on endoscopic findin&s



he overarchin& definition mandates that troublesome symptoms andor complications be present re

syndrome(s) present and that those syndromes are caused by reflu.*+



Joel E. Richter. Atlas of Gastroenterology, th

Edition, ,lac-ell /ublishin& td% 2001



%tiology

&astric acid pepsin

bile salts pancreas

en3ym

ifestylefactors


http://slidepdf.com/reader/full/gastroesophageal-reflux-disease1 8/22Joel E. Richter. Atlas of Gastroenterology, th Edition, ,lac-



&athophysiology

pa



Joel E

Gastro

,lac-



Manifestati

on of G%'#



The sy(pto(s pattern is very si(ilar in Gpatients )ith *%G%'#+ and )ithout esoph*%'#+ and hearturn is the (ost co((o

sy(pto(Hearturn

*"!!.+

ith esopha&itis

/elching

/loating 0do(inal pain

ausea

'egurgitation%pigastric pain

:cale ; < of patients ith symptom

ithout esop



Clinical &ictures

1 fenotipe of G%'#Nonerosive Refux

disease (#ERD)

-asence of visile

(ucosal in2ury*%ndoscopy-negative

re3u4 disease+

- could eco(es%G%'# 5 /arrett

Erosiveesophagitis

(EGERD)

- histopathologicallyde(onstrated

changes inesophageal (ucosa

6 78S 0G%7%SClassi$cation

BarreEsopha

- advance



#iagnosis

HISTOR$

Hearturn, 'e3u4

TRIAL PPI

High dose &&I id for 9-days *1!-;! (inutes ef

rea<fast and efore tevening (eal+

DIAG#OSTI%STUDIES

Suspected G%'#co(plications or

treat(ent failures



86

Grade

A=

Grade

A=

0undell et al 8111% /ublished .ith permission from /rofessor ! yt&at and /rofessor > $ent

?ne (or more) mucosal brea- no lon&er than @ mm%

that does not etend bet.een the tops of t.omucosal folds

The LA Classification system – Grade A reflux esophagitisThe LA Classification system – Grade A reflux esophagitis

8A

GradeB=

GradeB=

?ne (or more) mucosal brea- mdoes not etend bet.een the to

The LA Classification – Grade B reflux esoThe LA Classification – Grade B reflux eso

0undell et al 8111% /ublished .ith permission from



8B

Grade

C=

GradeC=

?ne (or more) mucosal brea- that is continuous bet.eenthe tops of t.o or more mucosal folds% but .hich involvesless than A@< of the circumference

The LA Classification system – Grade C reflux esophagitisThe LA Classification system – Grade C reflux esophagitis

0undell et al 8111% /ublished .ith permission from /rofessor ! yt&at and /rofessor > $ent81

Grade

D=

Grade

D=

?ne (or more) mucosal brea- .

A@< of the esopha&eal circumf

The LA Classification – Grade D reflux esoThe LA Classification – Grade D reflux eso

0undell et al 8111% /ublished .ith permission from



Manage(ent

Three 0pproach of



Three 0pproach of Therapy



Co(plication

%sophageal ulcer leedingStricture esophagus

/arrett=s esophagus > pre-cance

lesion *?-"! . fro( severeG%'#+

%sophageal Cancer



Managemefowchart

patients wi

SPRE

Fe'



&revention

!. "ace, G. #ianchi "orro. !astroe

$isease = /rinciples of $isease% $

reatment :prin&erCDerla&Eien

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