Disease( GERD)
Pendahuluan
• GER ( refluks gastroesofageal ) adalah
fenomena yang dapat timbul sewaktu-waktu
pada populasi umum , terutama sehabis
makan dan kemudian kembali seperti normal
refluks fisiologis.
• Dikatakan patologis (GERD) bila terjadi refluks
berulang dalam waktu lama sehingga menim
bulkan keluhan/kerusakan mukosa esofagus
• Terdapat peningkatan prevalensi GERD
PATOGENESIS GERD(1):
Refluks isi lambung kedalam
esofagus merupakan hal yang
normal.
Patologis bila terjadi gangguan
bersihan lumen esofagus terhadap isi
lambung
Proses berlangsung lama dan
berulang
PATOGENESIS GERD(2):
Terjadi penurunan resistensi
jaringan mukosa esophagus
Pola hidup tertentu, pola makan,
merokok, berat badan
Infeksi H pylori?
Penurunan tonus sfingter esofagus
bawah ?
GERD dan motilitas :
NERD
o Tidak ada kerusakan jaringan (endoskopi)
o Pemeriksaan pH esophagus hasil (+)
o Terapi empiris (PPI test) hasil (+)
Endoskopi
Pemeriksaan histopatologi
Pemeriksaan pH metri 24 jam
Penunjang diagnostik lain:
Esofagografi dengan barium, Manometri
esofagus
Savary-Miller classification
of esophagitis
Grade I
One or several erosions in one mucosal fold
Grade II
Several erosions in several mucosal folds,
the erosions can merge
Grade III
Erosions surrounding the oesophageal circumference
Grade IV
Ulcer(s), strictures, shortening of the oesophagus
Grade V
Barrett’s epithelium
Savary & Miller. The Esophagus. In: Handbook & Atlas of Endoscopy.
Solothurn, Switzerland: Verlag Gassman AG, 1978: 119–205.
Grade I esophagitis
Savary-Miller
classification
Savary-Miller
classification
Several erosions in
several mucosal folds,
the erosions can merge
www.gastrolab.net
Grade III esophagitis
Savary-Miller
classification
Erosions surrounding
the oesophageal
circumference
Savary-Miller
classification
Ulcer(s), shortening of
the oesophagus
Savary-Miller
classification
Moderate Barrett’s
oesophagus
Savary-Miller
classification
Stricture
Nadel, UCHC.
Grade V esophagitis
Savary-Miller
classification
Moderate Barrett’s
oesophagus
Savary-Miller
classification
Severe Barrett’s
oesophagus
Nadel/Saint Francis Hospital. In: Gastrointestinal Pathology. Fenoglio-Preiser, New York: Raven Press, 1989: 96–100.
Alarm features for GERD
Odynophagia
Dysphagia Bleeding
Alarm
features
Hiatus hernia
Esophageal stricture
Esophageal cancer
Chest pain of cardiac origin
Functional dyspepsia
Prokinetic
motility agents
Reduce weight
Modifications
Avoid reflux-promoting
agents (e.g. alcohol,
coffee, some foods)
(not evidence based)
Keluhan
UNINVESTIGATED INVESTIGATED
berulang
PENGOBATAN EMPIRIK 2
TERAPI
minggu ( PPI test ? )
AWAL / INITIAL
TERAPI TERAPI
“BILA PERLU” PEMELIHARAAN