Damage to LES structure—— Increased intra-abdominal pressure (such as obesity, pregnancy, constipation, etc.), hiatal hernia, Long-term increase in intragastric pressure (such as delayed gastric emptying, gastric dilation, etc.) Achalasia surgery

Causing LES dysfunction or transient flaccid prolongation— Certain hormones (such as cholecystokinin, glucagon, vasoactive intestinal peptide, etc.), Food (such as high fat, chocolate, etc.), Medications (such as calcium channel blockers, diazepam)

Disorders that cause abnormal esophageal motility and decreased salivation, such as Sjogren's syndrome

Hiatal hernia - part of the stomach enters the chest through the diaphragmatic hiatus, which not only changes the structure of the LES, but also reduces the esophageal clearance of reflux material

Long-term smoking, drinking, eating irritating food or drugs

Esophageal mucosal epithelial necrosis, inflammatory cell infiltration, mucosal erosion and ulcer formation

① Basal cell proliferation; ②The papilla of the lamina propria is extended and blood vessels proliferate; ③Inflammatory cell infiltration; ④Enlarged spaces between squamous epithelial cells

Typical symptoms

atypical symptoms

Refluxed material irritates or damages tissues or organs other than the esophagus, causing—— Chronic cough, pharyngitis, asthma, aspiration pneumonia, interstitial pulmonary fibrosis

Barrett's esophagus

Esophageal stricture

upper gastrointestinal bleeding

The most accurate way to diagnose RE

The RE classification (Los Angeles classification, LA) is as follows: Normal: There is no damage to the esophageal mucosa. Grade A: There is one or more esophageal mucosal damage with a length not exceeding 5 mm. Grade B: There is at least one damaged esophageal mucosa with a length exceeding 5 mm, but no confluent lesions. Grade C: The esophageal mucosa is damaged and fused, but less than 75% of the esophageal circumference. Grade D: The esophageal mucosa is damaged and fused, involving at least 75% of the esophageal circumference.

Barrett's esophageal mucosa is replaced by metaplastic columnar epithelium, which is orange-red, mostly located proximal to the dentate line at the gastroesophageal junction, and is island-shaped, tongue-shaped, or ring-shaped.

The “gold standard” for diagnosing GERD

Esophageal pH monitoring, Esophageal impedance-pH monitoring

Preoperative evaluation for antireflux surgery

Helps rule out esophageal cancer and other esophageal diseases

It is not advisable to lie in bed immediately after eating

It is not advisable to eat 2 hours before going to bed, and the head of the bed can be raised when sleeping

Pay attention to reducing factors that cause increased intra-abdominal pressure, such as obesity, constipation, etc.

Avoid foods that can trigger GERD symptoms, such as high fat, chocolate, coffee, etc.

Use with caution drugs that reduce LES pressure or cause delayed gastric emptying, such as nitroglycerin, calcium channel blockers, anticholinergics, etc.

Quit smoking and alcohol

Acid suppressants

Gastrointestinal motility drugs

antacids

Refractory GERD

Maintenance treatment

Symptoms still difficult to control despite adequate acid-suppressive treatment, Acid suppressive therapy is effective but requires long-term maintenance therapy and symptoms are due to reflux

Endoscopic treatment - endoscopic radiofrequency ablation, transoral non-incision fundoplication

Surgery—Laparoscopic Fundoplication

Barrett's esophagus

Esophageal stricture

upper gastrointestinal bleeding