GASTROESOPHAGEAL REFLUX

DISEASE
Lower
Esophageal
Sphincter
(LES)
> Relaxes to allow
swallowing
Angle of HIS
Fundus
Gastroesophageal
Flap Valve (GEV)
> 180 flap valve,
maintains closure
against lesser curve of
stomach
> Is closed by pressure in
the stomach to prevent
reflux
Esophagus
Diaphragm
Grays Anatomy, 1997
Z Line
> Marks where
stomach and
esophagus meet
Anatomy
Gastro Esophageal Reflux Disorder
The term REFLUX comes from the Greek word
meaning backflow, usually referring to the
contents of the stomach.
Just under the diaphragm, where the esophagus
and stomach connect, is the lower esophageal
sphincter (LES). This muscle normally prevents
stomach juices and food from coming back up,
relaxing only when swallow something.

Symptoms for GERD
Most common burning sensation in the chest,
(AKA Pyrosis or heartburn).
This sensation can also be associated with
position, sleep, or exercise.
Others include: belching, dysphagia,
odynophagia (pain on swallowing), water brash,
sore throat, cough, bronchospasms, atypical
chest pain, hoarseness, and asthma
exacerbation.
Symptoms are more common over night
Most common symptoms in the elderly include
dysphagia, vomiting, and respiratory problems.
Severe, long term affects
Gastrointestinal bleeding
Barretts esophagus
There is columnar epithelium in the
esophagus where stratified squamous
epithelium should be
Cancer Esophagus
Prevention/Lifestyle changes
The most important step is to minimize exposure to
those factors that interfere with the normal function
of the esophageal sphincter.
Meals should be eaten at least 2 hours before bedtime to
prevent stomach acids from moving up the esophagus.
Do not exercise immediately after a meal
Maintain a healthy body weight
Reduce stress
Elevate the head of the bed 4-6 inches. Simply sleeping on
extra pillows does not help since it flexes the stomach and
could actually worsen reflux. Tilting the entire bed upwards
will allow gravity to do its job.
Avoid tight clothing
Do not smoke
Medications
Reduce the acidity of the
stomach contents
Increase the activity of the
esophageal sphincters
They will increase the
motility of the stomach
Medications Continued
acid-blockers
They dont reduce reflux but they do reduce acidity.
"H-2 blockers :block the histamine 2 receptor that is
important in stomach acid production
Tagamet
Zantac
Pepcid
Proton pump inhibitor (PPI): reduce activity of a process
that "pumps" protons across the cell membrane
Prilosec
Prevacid
Reglan is also used to increase the activity of the
sphincter and increase gastric motility