GERD

The reflux of gastric contents into the lower esophagus is called GERD.

Causes
1.sliding hiatus hernia-in this type of hernia the esophagogastric junction slides up through the diaphragm.this results in....a. Loss of obliquity of entry of eso into stomach.b.loss of reinforcing effect of intra abdo. pressure on d lower eso. sphincter.these 2 factors facilitates reflux.
2. Cardiomyopathy and vagotomy
3. Pregnancy,obesity,ascites,wt lifting,straining.
4. Cig smoking,alcohol,fatty foods,caffeine
5. Large volume meals.
6. Systemic sclerosis.
7. Drugs lik aminophylline,beta agonist,nitrates,ca channel blockers.
8. H.pylori.

C/f
-heart burn is deply placed burning pain behind the sternum radiating to the throat.it occurs after meals brought on by bending lifting weight and straining. It occurs on lying down in bed at night and relieved by sitting up.
-regurgitation of contents into mouth.
-aspiration pneumonia
-odynophagia
-persistant n transient dysphagia
-anemia due to bld loss
-hoarseness,sore throat,cough,laryngitis,otitis media.



Investigations
-endoscopy
-barium swallow and meal for hiatus hernia
-eso. pH
-bernstein test
-resting ECG n stress ECG
-eso motility studies.

Treatment
General
-weight reduction. Cessation of smoking
-small volume feeds.
-avoid alcohol.fatty food.weight lifting.
-avoid late night meals

Medical
-liquid antacid 10 to 15ml, 1 and 3 hrs. After meals.
-H2 antagonists lik cimetidine 400mg or ranitidine 150mg twice daily
-proton pump inhibitors lik omeprazole 20-40mg/day,lanso 15-30,panto 40,esomeprazole 40
-metoclopramide/domperidone 10mg thrice daily.
-h.pylori Rx regime
-oral iron for anemia

Surgical
-resection of strictures
-surgical return of lower eso sphincter to abdo.
-fundoplication