GERD AND BARRETS

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GASTRO-OESOPHAGEAL REFLUX DISEASE
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INTRODUCTION

• Dyspepsia is defined as upper abdominal or
  retrosternal pain,discomfort,heartburn,nausea
  vomiting or symptoms considered to be referable
  to the proximal alimentary tract.
• It is a symptom complex rather than a specific
  disease
• It is a common complaint among patients in both
  general and gastroenterology practice.

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Definition

• Is a clinical manifestation of excessive reflux
  of acid gastric contents into the oesophagus
  causing various degrees of symptomatic irritation
  to the oesophageal mucosa with symptoms lasting
  gt6monthsGORD runs a chronic and relapsing
  courseTypical symptoms of GORD include
  heartburn, regurgitation and dysphagia.

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Epidemiology

• Is a very common disorder of the upper GIT
• Based on hospitalization and death rates the
  prevalence of GORD has increased while that of
  PUD has been on the decrease.
• GORD affects about 25-35 of the US population
• Limited no of hospital based studies have
  reported on GORD and its complication in African
  countries.

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• Ahmed et al reported 45 of patients with Erosive
  oesophagitis, Barretts 10.6 in a study of 105
  Sudanese patients with heartburn.
• In South Africa out of 216 consecutive Barretts
  only 5 were blacks despite the ratio of blacks
  to whites in the city being 51.(Mason et al)

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RISK FACTORS

• 1 Obesity
• 2 Smoking
• 3 Diet (fatty/spicy foods, peppermint, chocolate,
  citrus fruits, tomato based products, coffee)
• 4 Hiatus hernia

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PATHOPHYSIOLOGY

• -Results from an imbalance between defensive
  factors protecting the oesophagus (anti-reflux
  barriers, oesophageal acid clearance and tissue
  resistance) and aggressive factors from the
  stomach contents (gastric acidity and vol. and
  duodenal contents).
• -Anti-reflux barriers consist of Lower
  oesophageal sphincter (LOS).
• Clearance of the oesophagus depends on the
  oesophageal peristalsis, saliva pH and gravity.

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• Factors contributing to the pathogenesis of GORD
  include
• Defective LOS
• Hiatus hernia
• Impaired oesophageal peristalsis
• Delayed gastric emptying, gastric acid production
  as well as bile reflux.
• Influence of H. pylori.

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CLINICAL PRESENTATION

• Heartburn
• Regurgitation
• Dysphagia
• Chronic cough
• Dental erosion
• Intractable nausea
• Non cardiac chest pain
• Asthma

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DIAGNOSTIC EVALUATION

• Rest primarily on recognition of symptoms
• Oesophagogastroduodenoscopy,capsule endoscopy

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COMPLICATIONS

• Stricture
• Barretts oesophagus (columnar lined epithelium
  with incomplete intestinal metaplasia with goblet
  cells in the oesophagus regardless of the length
  of the change.
• Oesophageal adenocarcinoma

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EROSIVE OESOPHAGITIS
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Barretts Oesophagus
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Oesophageal Adenocarcinoma
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• Oesophageal manometry
• 24-hour pH monitoring

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MEDICAL AND SURGICAL TREATMENT

• Well taken history is still paramount
• Life style modification
• Patient education
• Elevation of the bed
• Decrease fat intake
• Cessation of smoking
• Cessation of alcohol
• Avoid recumbency 3hours postprandially

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• MEDICAL TREATMENT
• Antacids remain the drugs of choice for quick
  relief
• Proton pump inhibitors (inhibit day time
  nocturnal and meal related stimulated acid
  secretion)

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SURGICAL MANAGEMENT

• Patients who fail medical therapy or develop
  complications of GORD)
• Barretts (antireflux treatment and mucosal
  ablation)

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Barrett esophagus

• is defined by the metaplasia of existing squamous
  mucosa into a specialized intestinal-type mucosa.

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Barrett esophagus

• The importance of this metaplasia is the
  association of this condition with the
  development of adenocarcinoma of the esophagus.
• Elimination of the metaplastic mucosa may
  decrease the cancer risk.