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gastroesophageal reflux disorder (GERD) (clinical manifestation (heartburn…
gastroesophageal reflux disorder (GERD)
investigation
AXR
endoscopy
ambulatory pH monitoring
esophageal manometry 食管壓力測量
pathophysiology
defective lower esophageal sphincter function
poor esophageal motility
poor local defense mechanisms of esophageal mucosa
decrease saliva production
delayed gastric emptying
duodenogastric reflux with acid, pepsin & bile
frequent/ prolonged reflux
non-erosive esophagitis
erosive esophagitis/ Barrett's esophagus
esophageal carcinoma
increase intra-abdominal pressure
clinical manifestation
heartburn
dysphagia
bloating 腹脹
epigastric pain
early satiety
burping 打嗝
regurgitation 反流
food repeating
intervention
lifestyle modifications
small frequent meal
avoid fatty food, caffeine, alcohol, mints, chocolate, acid food
X tobacco
avoid eating before exercise
relaxation techniques to reduce stress
avoid tight clothing
sleep on left side & elevate bed (~6inch)
weight reduction
medication
antacid
h2 receptor antagonist
PPI
fundoplication
wrapping (360, 270, 180 of proximal stomach around the distal esophagus and lower esophageal sphincter
recreating angle of Hiss
returning the hiatal hernia sac to the abdominal cavity
experimental therapies
radiofrequency ablation
sewing machine