Gastroesophageal Reflux Disease (GERD) - CITO Review

Summary

This video explains Gastroesophageal Reflux Disease (GERD), a common condition where stomach acid or bile reflux into the esophagus, causing symptoms like heartburn, chest pain, and dysphagia. It highlights the imbalance between offensive factors (like increased acid) and defensive mechanisms (such as the lower esophageal sphincter). Risk factors include obesity, pregnancy, smoking, and certain medications. Diagnosis involves tools like the GERD questionnaire, PPI trials, and endoscopy. Treatment focuses on lifestyle changes, such as weight loss and avoiding trigger foods, alongside medications like PPIs and H2 blockers to manage symptoms effectively.

Takeaways

• 😀 GERD (Gastroesophageal Reflux Disease) is a common condition, often encountered in daily medical practice, and is part of the 4A competencies for doctors.
• 😀 The primary symptoms of GERD include heartburn and regurgitation, with complications potentially affecting the esophageal mucosa, detected through endoscopy.
• 😀 Risk factors for GERD include obesity, pregnancy, hiatus hernia, smoking, and the use of certain medications like theophylline, anticholinergics, nitrates, and calcium channel blockers.
• 😀 GERD occurs due to an imbalance between offensive factors (such as increased stomach acid) and defensive mechanisms (such as lower esophageal sphincter function).
• 😀 Defensive mechanisms that protect the esophagus include gravity, peristalsis, saliva, and bicarbonate, which reduce the time acid comes into contact with the esophagus.
• 😀 The lower esophageal sphincter (LES) and the diaphragm's crural muscles help prevent acid reflux; abnormalities in these structures can contribute to GERD.
• 😀 GERD can cause extra-esophageal symptoms like chronic cough, hoarseness, frequent phlegm, and dental erosions, leading to conditions like laryngitis, pharyngitis, and pulmonary fibrosis.
• 😀 Diagnosis of GERD involves clinical evaluation and a test called the 'GerdQ' questionnaire, with a score of 8 or higher indicating a high likelihood of GERD.
• 😀 Treatment often involves proton pump inhibitors (PPIs), with a trial therapy given for 1-2 weeks to evaluate response. If successful, PPIs may continue for up to 8 weeks.
• 😀 Lifestyle changes are crucial for managing GERD, including weight loss, avoiding trigger foods, quitting smoking, elevating the head while sleeping, and not eating 2-3 hours before bedtime.

Q & A

What is GERD and what are its main symptoms?

GERD (Gastroesophageal Reflux Disease) is a condition where stomach acid refluxes into the esophagus, causing symptoms such as heartburn, regurgitation, and in some cases, chest pain and difficulty swallowing (dysphagia). Other symptoms include chronic cough, hoarseness, and dental erosion.

What are the primary risk factors for GERD?

The primary risk factors for GERD include obesity, pregnancy, hiatal hernia, smoking, and the use of certain medications like theophylline, anticholinergics, nitrates, and calcium channel blockers. Additionally, certain foods such as fatty foods, coffee, and alcohol can trigger GERD symptoms.

How does the esophagus protect itself from acid reflux?

The esophagus has several defense mechanisms to protect itself from acid reflux, including the lower esophageal sphincter (LES), peristalsis, salivary bicarbonate, and the epithelial barrier. The LES prevents acid from flowing back into the esophagus, while peristalsis and gravity help move contents down. Saliva and bicarbonate neutralize acid, and the epithelial cells form a protective barrier.

What causes the relaxation of the lower esophageal sphincter (LES) in GERD?

In GERD, the relaxation of the lower esophageal sphincter (LES) can be caused by gastric distension, low LES pressure, or anatomical changes such as a hiatal hernia. This abnormal relaxation allows stomach acid to flow back into the esophagus.

What are the diagnostic methods for GERD?

Diagnostic methods for GERD include endoscopy to check for mucosal damage, pH monitoring (such as 24-hour pH tests) to measure acid exposure in the esophagus, and the PPI (proton pump inhibitor) trial test. The PPI trial involves administering double doses of PPI for 1-2 weeks to assess symptom relief.

What is the role of endoscopy in diagnosing GERD?

Endoscopy is used to identify damage to the esophageal mucosa and complications such as esophagitis, Barrett's esophagus, or esophageal cancer. It allows doctors to visually inspect the esophagus and take biopsies if needed.

What is the significance of alarm symptoms in GERD diagnosis?

Alarm symptoms such as dysphagia (difficulty swallowing), weight loss, or gastrointestinal bleeding are important indicators that GERD may have progressed to a more serious condition, such as esophageal cancer. If alarm symptoms are present, the patient should be referred for further evaluation at a higher-level healthcare facility.

What lifestyle changes should patients with GERD make?

Patients with GERD should aim to lose weight if they are overweight, avoid foods and drinks that trigger symptoms (such as fatty foods, coffee, and alcohol), avoid overeating, quit smoking, elevate the head of the bed while sleeping, and avoid eating 2-3 hours before bedtime.

What medications are commonly used to treat GERD?

The main medications used to treat GERD include proton pump inhibitors (PPIs) such as omeprazole, H2-receptor antagonists like ranitidine, and antacids. PPIs are typically used as the first-line treatment for GERD, while H2 blockers may be used for nocturnal symptoms.

What are the potential complications of untreated GERD?

Untreated GERD can lead to complications such as esophageal erosions, strictures, Barrett's esophagus (a pre-cancerous condition), and esophageal cancer. Long-term reflux can also cause extra-esophageal manifestations like laryngitis, pharyngitis, and pulmonary fibrosis.