Let’s check some important notes of GERD including clinical features, diagnosis and treatment
Factors preventing gastro-oesophageal reflux
- 1.Esophago-gastric angle
- 2.Pinchcock action of the right crus of diaphragm
- 3.Rosette like folds of mucous membrane at the cardia.
Etiology: Incompetence of the lower oesophageal sphincter(LES) causes gastro-esophageal reflux.
Important notes of Clinical features in GERD
- Retrosternal burning pain (heartburn) and epigastricpain which is aggravated by fatty foods (fattydyspepsia)–common symptom
- Dysphagia due to peptic strictureand opainful swalloing-odynophagia
- Recurrent pulmonary aspiration may cause aspirationpneumonia.
Diagnosis
1.Endoscopy – may show reflux esophagitis, pepticstricture or Barrett’s esophagus.
2.Manometry – to exclude achlasia.
3.24 hours pH recording – gold standard.
4. X-ray with Barium swallow
5.Bernstein test – acid infusion test.
Treatment
Medical- includes antiemetics (metoclopramide), PPIs(omeprazole).
b.Surgery- total (described by Nissen) or partialfundoplication (laparoscopic).