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Gastro/esophageal reflux disorder (GERD/GORD) (pathophysiology (Defective…
Gastro/esophageal reflux disorder (GERD/GORD)
Anatomy of the stomach
Prevent oesophageal reflux -> by pinchcock valve effect -> loss of this mechanism resulting in displaced gastroesophageal junction angle & leakage of gastric content to lower oesophagus
pathophysiology
Defective lower oesophageal sphincter function
poor oesophageal motility
increase intra-abdominal pressure
delayed gastric emptying
Frequent/ prolong reflux lead to: non-erosive oesophagitis (NERD), erosive oesophagitis/ Barrett's oesophagus
complications-> oesophageal carcinoma
Clinical manifestations
Cardinal
heartburn
dysphagia
bloating 腹脹
early satiety
investigation
AXR
Ambulatory pH monitoring
Endoscopy
oesophageal manometry
intervention
lifestyle modification
small & frequent meals
avoid fatty food, caffeine, alcohol, mints, chocolate & acid food
x tobacco
avoid eating before exercise
weight reduction
medications
antacids
histamine2 receptor antagonists
proton pump inhibitors
Fundoplication
wrapping (360/ 270/ 180 of proximal stomach around the distal oesophagus and lower oesophageal sphincter -> recreating the angle of hiss -> returning the hiatal hernia sac to the abdominal cavity
Experimental therapy
radiofrequency ablation
sewing machine