stomach contents -> back to esophagus. erosive or non-erosive. woman>men, increases with age. risk factors - smoking, caffeine, alcohol, stress, obesity, iatrogenic, inadequate saliva or peristalsis to protect, Gi malformations and tumors, obstruction, scleroderma, sliding hiatal hernia.
mechanism - gastroesophageal junction dysfunction. increased lower esophageal sphincter relaxation. imbalance, anatomical abnormalities. impaired esophageal acid clearance.
findings - superficial coagulative necrosis, thickening of basal layer, inflammatory cells. squamous -> columnar -> Barrett metaplasia.
typical symptoms - heartburn, regurgitation, dysphagia, odynophagia, excessive salivation. atypical - pressure on chest, bloating, epigastric pain, dyspepsia, nausea. other - chronic nonproductive cough and night time cough, hoarseness, dental erosions. aggravating factors - lying down after eating, certain foods and beverages.
diagnosis - before 60 with typical symptoms presume GERD and start PPI. after 60 alarm with atypical symptoms and do endoscopy. if other symptoms - exclude other causes.
EGD indications - dysphagia, odynophagia, early satiety, anemia or evidence of Gi bleeding, persisting vomiting, unintentional weight loss, aspiration pneumonia, risk factors of Barrett metaplasia. in inconclusive - barium swallow, esophageal manometry.
dietary and physical recommendations. reduce/avoid triggers. pharmacological - PPI for 8 weeks. surgical - no results, complications, Fundoplication - involves wrapping the top part of your stomach around your lower esophagus to narrow, and prevent reflux.
complications - Barrett esophagus, reflux esophagitis - most common. iron deficiency -> bleeding, anemia. esophageal stricture. aspiration pneumonia, chronic bronchitis, asthma. reflux laryngitis - hoarseness.