gastroesophageal reflux disease1
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GASTROESOPHAGEAL RE
DISEASE (GERD)
Centre of Gastroentero-Hepatology, Wahidin Sudirohusodo
Internal Medicine, Faculty of Medicine, Hasanuddin Univer
“UGI Disorders” Lecture in GEH Syste! F"UH
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#e$nition
“ A condition which develops when the refluxstomach contents causes troublesome sym
and/or complications." (Montreal 2006)
"troublesome" is that symptoms adversely a
patient's quality of life he definition of !#$ can% alternatively% b
based on endoscopic findin&s
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he overarchin& definition mandates that troublesome symptoms andor complications be present re
syndrome(s) present and that those syndromes are caused by reflu.*+
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Joel E. Richter. Atlas of Gastroenterology, th
Edition, ,lac-ell /ublishin& td% 2001
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%tiology
&astric acid pepsin
bile salts pancreas
en3ym
ifestylefactors
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7/17/2019 Gastroesophageal Reflux Disease1
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&athophysiology
pa
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Joel E
Gastro
,lac-
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Manifestati
on of G%'#
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The sy(pto(s pattern is very si(ilar in Gpatients )ith *%G%'#+ and )ithout esoph*%'#+ and hearturn is the (ost co((o
sy(pto(Hearturn
*"!!.+
ith esopha&itis
/elching
/loating 0do(inal pain
ausea
'egurgitation%pigastric pain
:cale ; < of patients ith symptom
ithout esop
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Clinical &ictures
1 fenotipe of G%'#Nonerosive Refux
disease (#ERD)
-asence of visile
(ucosal in2ury*%ndoscopy-negative
re3u4 disease+
- could eco(es%G%'# 5 /arrett
Erosiveesophagitis
(EGERD)
- histopathologicallyde(onstrated
changes inesophageal (ucosa
6 78S 0G%7%SClassi$cation
BarreEsopha
- advance
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#iagnosis
HISTOR$
Hearturn, 'e3u4
TRIAL PPI
High dose &&I id for 9-days *1!-;! (inutes ef
rea<fast and efore tevening (eal+
DIAG#OSTI%STUDIES
Suspected G%'#co(plications or
treat(ent failures
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86
Grade
A=
Grade
A=
0undell et al 8111% /ublished .ith permission from /rofessor ! yt&at and /rofessor > $ent
?ne (or more) mucosal brea- no lon&er than @ mm%
that does not etend bet.een the tops of t.omucosal folds
The LA Classification system – Grade A reflux esophagitisThe LA Classification system – Grade A reflux esophagitis
8A
GradeB=
GradeB=
?ne (or more) mucosal brea- mdoes not etend bet.een the to
The LA Classification – Grade B reflux esoThe LA Classification – Grade B reflux eso
0undell et al 8111% /ublished .ith permission from
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8B
Grade
C=
GradeC=
?ne (or more) mucosal brea- that is continuous bet.eenthe tops of t.o or more mucosal folds% but .hich involvesless than A@< of the circumference
The LA Classification system – Grade C reflux esophagitisThe LA Classification system – Grade C reflux esophagitis
0undell et al 8111% /ublished .ith permission from /rofessor ! yt&at and /rofessor > $ent81
Grade
D=
Grade
D=
?ne (or more) mucosal brea- .
A@< of the esopha&eal circumf
The LA Classification – Grade D reflux esoThe LA Classification – Grade D reflux eso
0undell et al 8111% /ublished .ith permission from
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Manage(ent
Three 0pproach of
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Three 0pproach of Therapy
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Co(plication
%sophageal ulcer leedingStricture esophagus
/arrett=s esophagus > pre-cance
lesion *?-"! . fro( severeG%'#+
%sophageal Cancer
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Managemefowchart
patients wi
SPRE
Fe'
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&revention
!. "ace, G. #ianchi "orro. !astroe
$isease = /rinciples of $isease% $
reatment :prin&erCDerla&Eien