Guidelines for the Diagnosis and Management of Gastroesophageal

Reflux Disease

Supervised by :Dr. Riki Tenggara, Sp.PD-KGEH,M.Kes

Presented by :Athalia Talaway 2013-061-0

Kezia Jessica 2014-061-038

Introduction

• GERD : symptoms or complications resulting from the reflux of gastric contents into the esophagus or beyond, into the oral cavity (including larynx) or lung.

• Classified as : – Non- erosive disease / NERD– Erosive disease / ERD

• Prevalence of GERD : 10–20% of the Western world with a lower prevalence in Asia.

• Clinically troublesome heartburn is seen in about 6% of the population

• Regurgitation was reported in 16% of the population

Epidemiology & Symptoms

• Chest pain • Dysphagia • Extraesophageal symptoms : chronic cough,

asthma, chronic laryngitis• Atypical symptoms : dyspepsia, epigastric

pain, nausea, bloating, belching

Epidemiology & Symptoms

1.

2

Diagnosis Recommendation

Heart Burn and Regurgitation

.

Non Cardiac Chest Pain

PPI

3.4.

Diagnosis Recommendation

Barium Radiograph

Endoscopy

Alarm SymptomsScreening high risk complication

7.

8.

9.

Diagnosis RecommendationRoutine Biopsies distal esophagus

Esophageal Reflux Monitoring

Endoscopic/surgical therapy NERDEvaluation refractory PPI

Diagnosis GERD

1.

2.

Management Recommendation

Weight loss

Head of bed elevationAvoidance meal 2-3 h before

bed time

3.

4.

Management Recommendation

8 weeks PPI30-60 minutes

before meal (1x)

Twice daily dosing: night-time symptoms,

variable schedules, sleep disturbance.

5.

6.

Management Recommendation

Maintenance PPI have symptoms after PPI is discontinued

erosive esophagitis Barrett’s esophagus.

Long term PPI lowest effective dose, including on demand/ intermittent therapy

7.

Management Recommendation

maintenance option in patients without erosive

disease H-2 Receptor Antagonist

Pro kinetic , Baclofen Diagnostic Evaluation

Summary of the evidence