Gastro-esophageal reflux disease

Gastro-oesophageal Reflux Disease(GORD/GERD)
prepared by: Ji Keon Looi
for pcl 9 Empty Nest

Introduction
•GOR is a normal physiologic event. However excessive exposure of the esophagus to stomach contents can lead to symptoms of complications (GORD)

Definition
•symptoms or mucosal damage (oesophagitis) resulting from the exposure of the distal oesophagus to refluxed gastric contents
•NB symptoms =/= mucosal damage

Pathophysiology
•Failure of the antireflux barrier
–Lower esophageal sphincter (LoS)
–Crural diaphragm (ext sphincter)
•Postprandial à Gastric distention àTransient relaxations of the LoS à Reflux episodes
•Decreased pressure of LoS (caffeine, nicotine, alcohol, fatty foods, chocolate)
Other factors
•Delayed gastric emptying
•Impaired oesophageal clearance
•Decreased salivary production

A myraid of causes
•Hiatus hernia (discussed later)
•Oesophagitis
–Acute inflammatory process in esophagus
•H. pylori
–Distal (antral) gastritis increases the production of gastric acid

Hiatus Hernia
•Part of the stomach protrudes through the oesophageal hiatus in the diaphragm
Hiatus hernia
•Most cases asymptomatic
•Impairs LoS function, increases likelihood of reflux
•large volumes of gastric contents pass unimpeded into the hiatal sac
•increased abdominal pressure on straining and even deep breathing may be enough to force refluxate into the oesophagus

Take home message
•The structure and function of the gastro-oesophageal junction is of key importance in reflux disease—as the condition becomes more severe, the risk of reflux during transient relaxations of the lower oesophageal sphincter rises and the volume of refluxate increases

•Fox M, Forgacs Ian, GORD, ; BMJ 2006