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:explode:GERD :explode: - Coggle Diagram
:explode:GERD :explode:
Pathogenesis
Gerd is defined as:
reflux of gastric acid and pesin for the stomach and into the esophagus.
The reflux of acidic contents irritates and inflames the esophagus causing discomforting symptoms.
What causes GERD
: Lower esophageal sphincter relaxations and other Lower esophageal sphincter abnormalities
What causes GERD:
Hiatal hernias, impaired esophageal clearance, and delayed gastric emptying.
Hiatal hernias promote LES dysfunction. Impaired gastric clearance promoted prolonged mucus exposure to gastric secretions. Delayed gastric emptying results in gastric distention. This can cause pressure and increase the rate of transient lower esophageal sphincter relaxations.
Injury to the esophageal tissue occurs as well as discomforting symptoms
Incidence/Prevalence
Effects approximately 20% of adults within western culture, being one of the most common gastrointestinal disorders.
The US has prevalence between 18.1-27.8% of individuals with GERD with it being slightly more common in men.
The prevalence could be even higher due to the fact that “individuals have access to over-the-counter acid reducing medications” making it hard to pinpoint the true value of how many people have GERD.
Risk Factors
medications for asthma, high blood pressure and more, such as Anticholinergics, Tricyclic Antidepressants, CCBs, ACE Inhibitors, Nitrates, Opioids, Progesterone, Sedatives and Theophylline
patients with a hiatal hernia - top of the stomach pushes up into the chest causing an increase of pressure in the stomach
Overweight
Pregnancy- causes pressure on the stomach, hormones such as estrogen and progesterone can weaken or relax the LES
smoking - weakens the LES
High sodium diet
Diagnostics
May be diagnosed by just a physical exam and reviewing signs and symptoms, but confirmed by different tests and procedures:
Upper endoscopy
: A flexible tube with a light and camera attached is inserted down the throat to visualize the esophagus and stomach. Even when reflux is present there may be no signs, but inflammation may be observed or a biopsy performed to test for Barrett’s esophagus.
Ambulatory acid probe test:
Monitor is placed in the esophagus to determine the time and duration of stomach acid there. May a thin tube that’s threaded through the nose into the esophagus or clip placed during an endoscopy.
Esophageal manometry:
Measures the muscle contractions and the coordination and force of the esophagus during swallowing
X-ray:
An x-ray of the upper digestive system taken after drinking a liquid that coats the inside lining. Also may swallow a barium pill that helps diagnose narrowing of the esophagus.
Clinical Manifestations
chest pain
difficulty swallowing
sensation of lump in your throat
regurgitation of sour liquid or food
A burning sensation in chest-typically after eating & worsens at night
chest pain gets worse when lying down
belching
nausea
Treatments
OTC Medications
antacids - neutralize stomach acids and promote gastric mucosal defense mechanisms - stimulate secretions of mucus, bicarbonate, and prostaglandins
H-2 receptor antagonists - decrease acid production from the stomach by blocking H2 receptors of parietal cells
Proton Pump Inhibitors - block acid production by irreversibly binding to H+/K+ ATPase enzyme
Prescription Medications
Prescription strength H-2 receptor antagonist
Prescription strength proton pump inhibitors
Medications to strengthen lower esophageal sphincter
Surgery & Other Procedures
Fundoplication - wraps stomach aground LES to tighten the muscle to prevent reflux
LINX device - ring of magnetic beads is wrapped around junction of esophagus and stomach so the magnetic force closes it
Transoral incisionless fundoplication (TIF) - tightens LES