DR Medhat MRCP

• DD (causes of heart burn sensation):
Cardiac pain (ACS).
Oesophageal carcinoma.
Oesophageal candidiasis or H. simplex
Drugs : e.g NSAIDS , Alendronate, ferrous sulphate & slow k.
• Treatment of GERD (stepwise or according to severity`see algorithm`):
1) Antacids & lifestyle measures :
- Stop smooking.
- Avoid pricipitants (spicy foods ,alcohol,stress,drugs).
2) PPI . ( the most effective in initial healing of reflux oesophagitis ,80-90% heal
within 8 weeks & in subsequent maintenance therapy).
3) Anti-reflux surgery (laparoscopic fundoplication). In PPI resist. or intolerance
4) TTT of emergency dysphagia & stricture :
- Urgent gastrograffin or barium swallow followed by endoscopy
- Biopsy & brushing to R/O malignancy.
- PPI.
- Oesophageal dilatation if stricture seen in endoscopy.
• Complications:
- Chronic reflux oesophagitis may lead to :
1) Barrett`s oesophagus ( = gastric or intestinal metaplesia of oesophagus):
o i.e Appearance of ectopic gastric & intestinal mucosa in the lower oesophagus i.e
replacement of usual oesophageal squamous epithelium by non-dysplastic
columnar epithelium (with goblet cells &brush borders).
o It`s premalignant ( increase risk of oesophageal adenocarcinoma by 50-100 fold).
سؤال only) o Diagnosis : only by endoscopic biopsy (not endoscopy
o Management :
Low grade dysplasia: high-dose PPI for 8-12 weeks
High grade dysplasia: surgery or cryotherapy.
2) Fibrosis & stricture of oesophagus.
• Disease association : common in Scleroderma.
N.B : - Symptoms don`t correlate with mucosal appearance in endoscopy in a patient
with GERD (i.e endoscopy may be normal despite symptoms)
- The most useful test to assess the role of surgery in GERD is oesophageal
motility and pH study.
- Monitoring of Ph is not good guide to therapy but symptomatic improvement
Is a good guide to the efficacy of therapy.
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