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GERD

GERD. Gastroesophageal Reflux Disease. Prof. Faisal Ghani Siddiqui FCPS; PGDip-bioethics; MCPS-HPE faisal@lumhs.edu.pk www.lumhs.edu.pk/faculties/surgery/gsurgery/faculty. PREAMBLE. What is GERD? LES? What causes GERD? How does GERD present? What are its complications?. INTRODUCTION.

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GERD

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  1. GERD Gastroesophageal Reflux Disease Prof. Faisal Ghani Siddiqui FCPS; PGDip-bioethics; MCPS-HPE faisal@lumhs.edu.pk www.lumhs.edu.pk/faculties/surgery/gsurgery/faculty

  2. PREAMBLE • What is GERD? • LES? • What causes GERD? • How does GERD present? • What are its complications?

  3. INTRODUCTION

  4. What is GERD? Condition characterized by heartburn andregurgitation due to the loss of the HPZ

  5. GERD • Common; Accounts for majority of esophageal pathologies • Chronic disease; needs life-long medical treatment • Surgery is effective; provides long-term relief

  6. PATHOPHY-SIOLOGY of gastroesophageal Reflux Disease

  7. LES HPZ located at the EG junction No distinct anatomical sphincter 3-4 cms long 10-25 mmHg Relaxes during swallowing / belching

  8. 3 Resting LES pressure Overall length of the sphincter Intra-abdominal length of the sphincter

  9. 3 Resting LES pressure Overall length of the sphincter Intra-abdominal length of the sphincter

  10. 3 Resting LES pressure Overall length of the sphincter Intra-abdominal length of the sphincter

  11. Permanently Defective LES • Mean resting pressure < 6mm • Overall length < 2cm • Intra-abdominal length < 1 cm

  12. of Gastroesophageal Reflux Disease SYMPTOMS

  13. Heartburn • Regurgitation • Dysphagia • Chest pain

  14. of Gastroesophageal Reflux Disease COMPLICATIONS

  15. Squamousepitheliumreplaced by columnarepithelium Norman Barrett 1950

  16. Barrett’s Esophagus Endoscopically identified columnar mucosa, which on biopsy shows intestinal mucosa with goblet cells

  17. DYSPLASIA

  18. MANAGE-MENT of Gastroesophageal Reflux Disease

  19. Management of GERD

  20. Management of GERD

  21. CONSERVATIVE TREATMENT • Antacids • Alginic acid • Metoclopromide / domperidone • Proton pump inhibitors • Change in life style

  22. Change in Life-style • Elevate head of the bed • Avoid tight fitting clothes • Eat small, frequent meals • Avoid eating before bedtime • Dietary changes

  23. PPI’s suppress acidity & relieve symptoms but do not control reflux Control of refluxbetter than control of symptoms!

  24. Antireflux surgeryeliminates reflux!

  25. Management of GERD

  26. INVESTIGATE IF SYMPTOMS… • Persist or progress • Recur

  27. INVESTIGATIONS • Endoscopy • 24-hour pH monitoring • Manometry

  28. Management of GERD

  29. WHEN TO OPERATE? • Persistent or progressive disease • Young patients with documented reflux • Stricture • Barrett’s esophagitis

  30. GOAL OF SURGERY to restore normal structure/pressure of the LES while preserving patient’s ability to swallow, and to belch

  31. PRINCIPLES • Restore pressure (>12 mmHg) • Restore length (at least 3 cm) • Place adequate length in abdomen (1.5 – 2 cm)

  32. ANTIREFLUX PROCEDURES • Nissen fundoplication • Toupet partial fundoplication • Belsey Mark IV partial fundoplication

  33. COMPLICATIONS • Temporary dysphagia • Inability to vomit • Increased flatulence

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