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By Kunkun Achmad MS

GastroEsophageal

Reflux isease

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DEFINISI The Montreal Definition :

A condition thatdevelops when the

reflux of stomachcontents causestroublesome symptomsand/or complications

Vakil N, et al. Am J Gastroenterol. 2006

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GERD Pathophysiology :

3-Part Process

1) Decreased basal lower

esophageal sphincter (LES)pressure

2) Decreased acid clearance3) Refluxate of acid and pepsin

injures the esophageal mucosa

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2 Groups of GERD

Erosive esophagitis3-5% Asian countries (14-15% Taiwan andJapan)10-20% Western countries

Non-erosive Reflux Disease (NERD)90% asian countries

70% Western countries

Fock KM et al. J Gastroenterol Hepatol 2008

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Classic Symptoms

Heartburn

Regurgitation

Malfertheiner P, et al.Dig Dis. 2008;26(3):231-6

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Atypical/Extra-esophageal

ManifestationsAtypical Extra-esophageal Chest pain Oral - Pulmonary Chronic

Epigastric pain Dental erosion cough Asthma

Nausea Pharyngo-laryngeal AspirationPulmonary

Pharyngitis/Laryngitis fibrosis

Hoarseness

Globus sensation - OtherSore throat Sleep

abnormalities

Vocal cord polyps

Posterior laryngitis

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DIAGNOSTIC OF GERD

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International Consensus

GERD is a symptom-baseddiagnosis, and hence symptomevaluation will remain theprimary means by whichtreatment decisions are madefor patients with suspectedGERD

Hunt R, et al. Dis Esophagus.2009

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Tests to diagnose GERD

Proton pump inhibitor test (PPI Test)

Endoscopy

Ambulatory 24-hour esophageal pHmonitoring

Esophageal manometry

Radiography

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Therapeutic Trial: a diagnostic tool

(?)

The use of a short course ofhigh dose PPI as a test in

diagnosing GERD

To achieve a significant

symptomatic improvement within ashort period of drug administration

Fass R, Hepato-Gastroenterol, 2001

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THERAPEUTIC

MODALITIES

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Lifestyle Modifications

Avoid Caffeine

Sodas * Fatty food

* Alcohol* Smoking

* Citrus & tomatoes

* Spicy foods

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Lifestyle Modifications

Avoid assuming

supine position for 3-4

hours after meals

Elevate head whilesleeping

Weight management

Avoid tightening your

belt or girldles

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MEDICAL

MANAGEMENT

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Acid-Suppression Therapy

H2RAs / H2 Blockers

* Ranitidine, famotidine, nizatidine,

and cimetidine

PPIs

* Omeprazole, esomeprazole,

lansoprazole, pantoprazole, and

rabeprazoleAcid suppression is the stronghold in

GERD management

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Treatment Duration

48 weeks for Typical GERD

6 months forAtypical GERD (withextra-esophageal manifestations)

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RECURRENCE

May employ on-demand strategy of

treatment

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Surgical TreatmentAntireflux surgery (Nissen/Toupet

fundoplication) is offered to patients in

the hope of obviating the need for

continuous medical therapy. Positive predictors:

* good response to medical therapy

* less than 50 yrs old* presence of typical GERD

symptoms

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