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Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD). * Definition : inflammation of the lower part of the esophagus due to abnormal reflux of gastric contents into the esophagus Often chronic and relapsing.

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Gastroesophageal Reflux Disease (GERD)

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  1. Gastroesophageal Reflux Disease (GERD)

  2. * Definition: inflammation of the lower part of the esophagus due to abnormal reflux of gastric contents into the esophagus • Often chronic and relapsing

  3. GERD is due to weakness of the lower esophageal sphincter (LES) leading to reflux of the acidic gastric content to the lower part of the esophagus.

  4. * Risk factors: - Obesity- Sliding Hiatal hernia- Pregnancy- Smoking- Delayed stomach emptying- Connective tissue disorders, such as scleroderma- Alcoholism.

  5. * Clinical Manifestations: 1. Heartburn: retrosternal burning discomfort. 2. Regurgitation: effortless return of gastric contents into the pharynx without nausea, or abdominal contractions. To be differentiated from vomiting. 3. Dysphagia: difficulty in swallowing 4. Extra-esophageal manifestations: laryngitis, chronic cough

  6. * Morphological features of GERD: * Grossly: the lower part of the esophagus is red, and may shows erosions.

  7. * Microscopically: 1. Inflammatory cellular infiltrate in the squamous epithelium including neutrophils, esinophils and lymphocytes. 2. Basal cell hyperplasia. 3. Acute inflammation of the sub epithelium (lamina propria)

  8. Esophagogastrodudenoscopy * Investigations: • Indications (with biopsy if needed): • In patients with alarm signs/symptoms • Those who fail a medication trial • Those who require long-term treatment.

  9. * Complications of GERD: • Erosive esophagitis • Stricture of esophagus due to healing by fibrosis. • Barrett’s esophagus

  10. Erosive esophagitis: • Responsible for 40-60% of GERD symptoms

  11. Esophageal stricture • Result of healing of erosive esophagitis • May need dilatation

  12. Barrett’s Esophagus: • Transformation of the stratified squamous epithelium of the lower end of the esophagus into intestinal epithelium (glandular metaplasia). • The clinical significance of Barrett’s Esophagus is that it is associated with the development of dysplasia and subsequently adenocarcinoma.

  13. References: Robbins and Cotran’s: Pathologic Basis of Disease. Seventh edition.

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