GORD (GERD) Gastro Oesophageal Reflux Disease - Overview pathophysiology, treatment

Summary

Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder affecting up to 15% of individuals weekly. It occurs when stomach contents backflow into the esophagus due to a malfunctioning sphincter, causing symptoms like heartburn and regurgitation. The esophagus has distinct structural differences between its upper and lower thirds, impacting its function. Diagnosis typically involves patient history and may include endoscopy or pH monitoring. Treatment focuses on lifestyle modifications and medications like proton pump inhibitors. Complications can include esophagitis and Barrett's esophagus, significantly increasing cancer risk. Effective management is crucial for patient health.

Takeaways

• 😀 GERD (gastroesophageal reflux disease) is a common gastrointestinal disorder affecting about 15% of individuals who experience heartburn or regurgitation weekly.
• 🧠 The esophagus has two main sections: the upper two-thirds with skeletal muscle and the lower third with smooth muscle, impacting how it functions.
• 🔄 The Z-line marks the transition from squamous to columnar epithelium in the esophagus, important for understanding GERD's anatomy.
• 💡 Parietal cells in the stomach produce hydrochloric acid, stimulated by factors such as histamine, which increases acid production.
• ⚠️ Increased intra-gastric pressure from large meals, chronic coughing, and decreased sphincter tone due to medications or lifestyle can contribute to GERD.
• 🔥 Symptoms of GERD include heartburn, chest pain, acid regurgitation, and dysphagia, which can worsen after meals or when lying down.
• 🔍 Diagnosis typically relies on patient history, but further investigations like endoscopy and pH monitoring may be necessary for persistent cases.
• 🍏 Management of GERD involves lifestyle changes like weight loss, smaller meals, and avoiding trigger foods, along with pharmacological treatments.
• 💊 Proton pump inhibitors (PPIs) and antacids are the main medications used to reduce stomach acid production in GERD patients.
• ⚠️ Complications of untreated GERD can include esophagitis, strictures, and Barrett's esophagus, significantly increasing the risk of esophageal adenocarcinoma.

Q & A

What is Gastroesophageal Reflux Disease (GERD)?

GERD is one of the most prevalent gastrointestinal disorders, characterized by the backflow of gastric acid and contents into the esophagus, causing symptoms such as heartburn and regurgitation.

What percentage of individuals experience heartburn or regurgitation at least once a week?

Up to 15% of individuals experience heartburn and/or regurgitation at least once a week.

How is the esophagus anatomically structured?

The esophagus is divided into an upper two-thirds made of stratified skeletal muscle and a lower third composed of smooth muscle, with differing types of epithelial cells lining each section.

What role do parietal cells play in gastric physiology?

Parietal cells are responsible for producing hydrochloric acid, which aids in food digestion. They utilize a proton pump to secrete hydrogen ions and maintain acid levels in the stomach.

What factors can increase the risk of developing GERD?

Factors include increased intragastric pressure from chronic coughing, large meals, delayed gastric emptying, and decreased esophageal sphincter tone due to alcohol, certain medications, and conditions like scleroderma.

What are some common symptoms of GERD?

Common symptoms include heartburn, regurgitation, odynophagia (pain when swallowing), chronic cough, laryngitis, and morning hoarseness.

How is GERD diagnosed?

Diagnosis is often made through patient history, but further investigations like endoscopy, barium swallowing studies, or 24-hour ambulatory pH monitoring may be used for persistent or severe cases.

What lifestyle modifications can help manage GERD symptoms?

Lifestyle changes include weight loss, smoking cessation, eating smaller meals, avoiding meals before sleep, and steering clear of trigger foods like spicy foods and alcohol.

What are the primary pharmacological treatments for GERD?

Pharmacological treatments include proton pump inhibitors (PPIs) to reduce acid production, antacids to neutralize stomach acid, and histamine receptor antagonists to inhibit acid secretion.

What are the potential complications associated with GERD?

Complications include esophagitis, esophageal strictures, Barrett's esophagus, and an increased risk of esophageal adenocarcinoma.