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GORD

Definition 
  • (NB some reflux is perfectly normal)
  • Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus.
  • Retrograde flow of gastric juice (GASTRIC ACID) and/or duodenal contents (BILE ACIDS; PANCREATIC JUICE) into the distal ESOPHAGUS
  • Commonly due to incompetence of the LOWER ESOPHAGEAL SPHINCTER. 
  • Gastric regurgitation is an extension of this process with retrograde flow into the PHARYNX or MOUTH.
  • Los Angeles classification
    • 1: 1 mucosal break <5mm
    • 2: > 5mm long
    • 3: Continuous between 2 mucosal folds
    • 4: Break >75% of mucosal circumference
Risk Factors Differential diagnosis 
Epidemiology
  • Incidence: 36% in U.S.
  • Most take OTC medications and do not seek medical help
  • GERD patients wait 1-3 years before seeing a doctor
Aetiology
  • Transient relaxation of lower esophageal sphincter
Clinical features 
  • Heartburn (Initial GERD symptom)
    • Location: Epigastric and retrosternal Chest Pain
    • Characteristic: Caustic or stinging
    • No radiation to the back
  • Acid Regurgitation (Water Brash or Pyrosis)
    • Suggests progressing GERD
    • Provoked by lying supine or leaning forward
    • Regurgitation of digested food or clear burning fluid
    • Undigested food suggests alternative diagnosis
      • Achalasia
      • Esophageal Diverticulum
  • Difficult swallowing (Dysphagia)
    • See Dysphagia from Esophageal Cause
    • Mechanical obstruction of solid foods
      • Suggests peptic stricture
    • Liquid obstruction suggests alternative diagnosis
      • Neuromuscular disorder
      • Neoplasm
      • Esophageal diverticulum
  • Atypical
  • Signs: Orofacial effects of chronic Acid Reflux
Pathophysiology

InvestigationsManagement

a) conservative
  • Drink 8 glasses (8 ounces) non-caffeinated fluid daily
  • Decrease provocative foods
    • Decrease or eliminate caffeine
    • Avoid spicy foods
    • Avoid milk products toward end of day
    • Avoid chocolate
    • Avoid fatty foods
  • Tobacco Cessation
  • No eating food 2-3 hours before bedtime
  • Elevate head of bed to 30 degrees
    • Place 6-8 inch blocks under legs at head of bed
    • Place Styrofoam wedge under mattress
  • Symptomatic therapy for mild intermittent symptoms
b) medicalc) surgical
Prognosis
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