PATOFISIOLOGI GERD

Summary

This presentation discusses Gastroesophageal Reflux Disease (GERD), its pathophysiology, symptoms, diagnosis, and treatment options. GERD is a condition where stomach acid flows back into the esophagus, causing symptoms like heartburn, regurgitation, and nausea. It can lead to complications such as esophagitis and even esophageal cancer. The presentation covers different types of GERD, including erosive and non-erosive forms, and details treatment methods such as Proton Pump Inhibitors (PPI), H2 receptor antagonists, and antacids. Emphasis is placed on the underlying causes of GERD, including malfunction of the lower esophageal sphincter and the importance of lifestyle changes and medication in managing the condition.

Takeaways

• 😀 GERD (Gastroesophageal Reflux Disease) is a condition where stomach acid refluxes into the esophagus, causing symptoms like heartburn, regurgitation, and difficulty swallowing.
• 😀 GERD can be classified into two types: erosive GERD (with esophageal mucosal damage) and non-erosive GERD (without visible mucosal damage on endoscopy).
• 😀 Typical symptoms of GERD include heartburn (burning sensation in the chest or upper abdomen), regurgitation (acidic or bitter taste), nausea, and dysphagia (difficulty swallowing).
• 😀 Extra-esophageal symptoms of GERD can include chronic cough, asthma, and laryngitis.
• 😀 The pathophysiology of GERD involves an imbalance between aggressive factors (stomach acid) and defensive factors (like the lower esophageal sphincter and esophageal mucosa).
• 😀 The lower esophageal sphincter (LES) plays a crucial role in preventing stomach acid from entering the esophagus. Dysfunction of the LES is a common cause of GERD.
• 😀 GERD can be caused by factors like weakened LES pressure, medications, certain foods, hormonal changes, or structural abnormalities in the esophagus.
• 😀 Treatment options for GERD include Proton Pump Inhibitors (PPI), H2 receptor antagonists, antacids, and prokinetic agents to reduce acid production or enhance esophageal motility.
• 😀 Proton Pump Inhibitors (PPIs) are highly effective in reducing stomach acid production by up to 90%, offering relief from GERD symptoms.
• 😀 The initial treatment for GERD typically involves a single dose of PPI for 8 weeks, with potential adjustments based on symptom persistence.
• 😀 Diagnosing GERD often relies on clinical symptoms like regurgitation and heartburn, and may be further confirmed with additional tests like PPI therapy.

Q & A

What is GERD (Gastroesophageal Reflux Disease)?

GERD is a condition where stomach contents, including acid, reflux into the esophagus, causing typical symptoms such as heartburn, regurgitation, and a bitter taste in the mouth. This can lead to esophageal mucosal damage and complications like Barrett's esophagus.

What are the two main types of GERD?

The two main types of GERD are erosive GERD (also known as erosive esophagitis) and non-erosive reflux disease (NERD). Erosive GERD is characterized by reflux symptoms with damage to the lower esophagus, while NERD presents with reflux symptoms but no mucosal damage on endoscopy.

What are the typical symptoms of GERD?

Typical symptoms of GERD include heartburn, which is a burning sensation in the chest, regurgitation of acid, bloating, nausea, difficulty swallowing (dysphagia), and even chest pain. Additional symptoms may include chronic cough, asthma, and laryngitis.

What causes the heartburn sensation in GERD patients?

Heartburn in GERD patients occurs when stomach acid refluxes into the esophagus, irritating the esophageal lining. This leads to a burning sensation in the chest, which can be more intense when lying down or after eating.

What is the role of the lower esophageal sphincter (LES) in GERD?

The lower esophageal sphincter (LES) is a muscle that separates the esophagus from the stomach. In a healthy person, it prevents stomach contents from flowing back into the esophagus. In GERD, the LES may be weakened or malfunction, allowing acid to reflux into the esophagus.

How is GERD diagnosed?

GERD is primarily diagnosed based on clinical symptoms such as heartburn and regurgitation. Additional tests may include an endoscopy to observe any esophageal damage and a PPI (Proton Pump Inhibitor) trial to see if symptoms improve with acid suppression.

What are some common medications used to treat GERD?

Common medications for GERD treatment include Proton Pump Inhibitors (PPIs) like omeprazole, lansoprazole, and esomeprazole, which reduce stomach acid production. Other treatments include H2 receptor antagonists (like ranitidine), antacids, and prokinetic agents to enhance gastric motility.

What is the mechanism of action of Proton Pump Inhibitors (PPIs)?

PPIs work by blocking the proton pump in the parietal cells of the stomach, which is responsible for secreting stomach acid. This inhibition reduces acid production, providing relief from GERD symptoms and promoting healing of esophageal mucosal damage.

How do H2 receptor antagonists (H2RAs) help treat GERD?

H2 receptor antagonists, such as ranitidine and famotidine, work by blocking histamine H2 receptors on parietal cells in the stomach. This decreases acid secretion, reducing GERD symptoms like heartburn and regurgitation.

What is the pathophysiology behind GERD?

The pathophysiology of GERD involves an imbalance between offensive factors (such as gastric acid) and defensive mechanisms (like the LES and esophageal mucosal protection). When the LES is weakened or malfunctioning, acid reflux occurs, leading to inflammation and potential damage to the esophageal lining.