Skip to main content

Gastro-esophageal reflux disease (GERO)

 


Gastro-esophageal reflux disease(GERO) 

Overview GE reflux is generally a result of transient relaxation of the lower esophageal sphincter (LES). The transient relaxation is a vagally mediated reflex, which is the physiologic mechanism of belching. Transient relaxations occur at increased frequency with gastric distension and in the upright position. Hiatal hernia is risk factor for factor for GERD. LES pressure is increased by motilin, acetylcholine, and possibly gastrin. Therefore, drugs that increase these mediators tend to decrease reflux. LES pressure is decreased by progesterone (pregnancy increases GE reflux), chocolate, smoking, and some medications, especially those with anticholinergic properties. 

Suspect GE reflux disease (GERD) in patients with a persistent, nonproductive cough, especially with hoarseness, continual clearing of the throat, and a feeling of fullness in the throat. This cough is commonly worse at night when the patient is supine. 

Most non-cardiac chest pains (70%) are caused by GERD! Most other GI-related chest pains are due to motility disorders. Note: These pains are not necessarily associated with pyrosis (heartburn) or dysphagia.

Extraesophageal manifestations of GERD: 

  • Nocturnal cough 
  • Frequent sore throat 
  • Hoarseness, laryngitis, 
  • Loss of dental enamel 
  • Exacerbation of asthma 
  • VCD (vocal cord dysfunction)
GERD is associated with two respiratory disorders: asthma and VCD. Some asthma patients, even without symptoms of GERD, have improvement of their asthma symptoms with GERD treatment. In the workup of GERD, always ask about asthma symptoms-especially those occurring at night. Note: A recent study showed that treatment of asymptomatic GERD in patients with severe asthma did not improve asthma control.

Do not assume asthma is the culprit in patients who complain of nocturnal symptoms. VCD is spasm of the vocal cords with associated inspiratory stridor. Patients will tell you that they are wheezing at night and may not really know if it is inspiratory or expiratory. Pulmonary function testing may be necessary to help distinguish vocal cord dysfunction from asthma. VCD is not always due to GERO; it is more typically seen in young adults who engage in competitive sports and is thought to be a stress reaction. About I 0% of exercise-induced "asthma" is now thought to be misdiagnosed VCD.

Increased body mass index (BMI) is associated with increased incidence of both GERO and asthma. Complications: esophageal ulcers, stricture, bleeding, and Barrett esophagus.

Diagnosis of GERO 
If the patient has only the classic symptoms of heartburn without alarm signals, the diagnostic workup starts with a therapeutic trial of PPis-EGD is indicated only if this trial fails.
Alarm signals in GERO indicating the need for EGO: 
  1. Nausea/Emesis 
  2. Blood in the stool 
  3. Family history of PUD 
  4. Weight loss 
  5. Anorexia 
  6. Iron deficiency anemia 
  7. Abnormal physical exam 
  8. Long duration of frequent symptoms, especially in Caucasian males > 50 years old 
  9. Failure to respond to full doses of a PP! 
  10. Dysphagia/Odynophagia 

EGO also is done if you suspect Barrett esophagus. 
If the patient has obstructive symptoms, you can do a barium swallow before endoscopy. 

Note: 62% of patients with GERO symptoms have a normal esophagus. This is termed nonerosive reflux disease or NERD!.

Treatment 
General measures. Many patients with reflux symptoms (∼50%) can be treated successfully with simple antacids, loss of weight, and raising the end of the bed at night. Precipitating factors should be avoided, and chocolate consumption and cessation of smoking. These measures are simple to say yet difficult to carry out, but are useful in mild cases. Medication that potentiates reflux, e.g. antimuscarinics, calcium channel blockers and bisphosphonates, should be stopped if possible.

 

Comments

Post a Comment

Popular posts from this blog

WACYIGELIN: KA HORTAGGA IYO MAAREYNTA CUDURKA Gowracatada ( AF SOMALI )

WACYIGELIN: KA HORTAGGA IYO MAAREYNTA CUDURKA Gowracatada Wasaaradda Caafimaadka iyo Adeegga Bulshada ee Dowladda Federaalka Soomaaliya ayaa si rasmi ah u shaacisay in kordhay kiisaska la soo sheegay ee Gowracatada, oo ah cudur halis ah oo si fudud u faafa, kaas oo hadda saameeyay degmooyin badan oo ka tirsan magaalada Muqdisho iyo deegaannada ku dhow. Gowracatada waa cudur khatar ah oo uu keeno bakteeriyada Corynebacterium diphtheriae. Cudurku inta badan wuxuu ku dhacaa carruurta, balse dadka waaweynna wuu ku dhici karaa. CALAAMADAHA IYO ASTAAMAHA Gowracatada: 1. Qandho fudud oo si tartiib ah ku bilaabata 2. Cunno xanuun daran, gaar ahaan marka la liqayo 3. Xanuun cunaha ah, codka oo qallala (hoarseness), iyo qufac joogto ah 4. Barar qoorta ah (qanjirrada qoorta oo weynaada) – badanaa carruurta ku badan 5. Xuub caddaan ama cawl ah oo daboolaya cunaha ama hunguriga – taas oo keeni karta neefsashada oo ku adkaata 6. Daal, lalabo iyo neefsashada oo yaraata 7. Xaaladaha daran, cudurku wux...
Post a Comment
Read more

AWARENESS: PREVENTION AND MANAGEMENT OF DIPHTHERIA

AWARENESS: PREVENTION AND MANAGEMENT OF DIPHTHERIA The Ministry of Health and Human Services of the Federal Government of Somalia has officially announced an increase in reported cases of Diphtheria, a serious and contagious illness, currently affecting multiple districts in Mogadishu and surrounding areas. Diphtheria is a potentially life-threatening bacterial infection that primarily affects children but can also infect adults. It is caused by the bacterium Corynebacterium diphtheriae. CLINICAL SIGNS AND SYMPTOMS OF DIPHTHERIA: 1. Mild fever with a gradual onset 2. Severe sore throat, especially during swallowing 3. Throat pain, hoarseness, and persistent coughing 4. Swelling of the neck (cervical lymphadenopathy) – particularly in children 5. Presence of grayish or whitish pseudomembrane covering the throat or pharynx – which may lead to breathing difficulty 6. Fatigue, nausea, and shortness of breath 7. In severe cases, the infection can involve the heart (myocarditis) and nervous ...
Post a Comment
Read more

Everything You Should Know About Acute Flaccid Paralysis

Acute flaccid paralysis (AFP) is a severe medical condition characterized by rapid onset of muscle weakness or paralysis and mainly affects children. The group of symptoms and signs, not a single disease, often affects muscles involved in breathing or swallowing. The condition, which often affects one leg or arm and is not typically linked to injury, primarily affects children under 15. AFP is associated with a variety of causes, including viral infections such as poliovirus, enterovirus and adenovirus, Campylobacter infections, as well as autoimmune diseases such as Guillain-Barré syndrome (a disorder where the immune system attacks the nerves) and transverse myelitis (inflammation of the spinal cord). AFP case definition any patient who under 15 years of age with acute flaccid  paralysis, or  A patient of any age in whom a clinician suspect polio   Classic example of syndromic surveillance      Several other conditions may look like clinical polio (E...
Post a Comment
Read more

"Hypothyroidism: Understanding the Causes, Symptoms, and Treatment Options"

  What is the thyroid gland? The thyroid gland is located in the throat, on both sides of the upper part of the trachea,  What is hypothyroidism? The operation of the thyroid gland means that the level of hormone secretion decreases, if the body does not produce enough hormones, the person feels or shows several symptoms that are characteristic of this disease. Thyroid disease is common in middle-aged women, it is very common in our Somali women, but unfortunately doctors do not recognize it quickly, as the symptoms can resemble other diseases such as rheumatism, heart disease, cholesterol disease, brucellosis, calcium deficiency and the disease known as "Fibromyalgia", so if you see the symptoms of this disease, the doctor should examine you for all these diseases to make sure which one you claim. In this thyroid disease it is necessary for the body to get the missing hormone. What are the symptoms of thyroid dysfunction? The first symptoms to notice are: 1- Laziness and fat...
Post a Comment
Read more

Health Benefits Of Nitric Oxide Containing Food

  Explore The Powerful Health Benefits Of Nitric Oxide Containing Food If you're looking to boost your overall health and vitality, it's worth exploring the incredible benefits of consuming foods that are rich in nitric oxide. Nitric oxide is a natural molecule that our bodies produce to help with various functions, including blood flow, cardiovascular health, athletic performance, and brain function. Incorporating nitric oxide-rich foods into your diet can be an effective way to enhance these areas of your health. Before we delve into the health benefits of nitric oxide-containing foods, let's first understand what nitric oxide is and how it works in our bodies. Nitric oxide is a gas that's produced by the lining of blood vessels, and it helps to relax and widen those vessels, improving blood flow and oxygen delivery throughout the body. It also plays a role in various other functions, including immune system regulation, neurotransmitter release, and muscle growth and ...
Post a Comment
Read more