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Internal Medicine-Gastroesophageal Reflux
gastroesophageal reflux disease (GERD), a disease caused by the reflux of gastroduodenal contents into the esophagus, causing uncomfortable symptoms and/or complications.The diagram explores its definition, pathogenesis, and pathology, detailing key contributing factors such as lower esophageal sphincter dysfunction, increased intra-abdominal pressure, and impaired mucosal barrier function. It also distinguishes between reflux esophagitis (RE) and non-erosive reflux disease (NERD), explaining their impact on esophageal tissue and associated symptoms.
Edited at 2024-10-27 16:50:51- Fortpflanzungssystem
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Internal Medicine-Gastroesophageal Reflux
- Fortpflanzungssystem
Diese Vorlage zeigt die Struktur und Funktion des Fortpflanzungssystems in Form einer Mind Map. Es führt die verschiedenen Komponenten der internen und externen Genitalien ein und sortiert das Wissen eindeutig aus, um Ihnen dabei zu helfen, mit den wichtigsten Wissenspunkten vertraut zu werden.
- Interpretation und Zusammenfassung des Beziehungsfeldes E-Book
Dies ist eine Mind Map über die Interpretation und Zusammenfassung des Beziehungsfeldes E-Book, des Hauptinhalts: Überblick über die Essenzinterpretation und Übersicht über das Feld E-Book. "Relationship Field" bezieht sich auf das komplexe zwischenmenschliche Netzwerk, in dem ein Individuum andere durch spezifische Verhaltensweisen und Einstellungen beeinflusst.
- Buchhaltungsbücher und Buchhaltungsunterlagen
Dies ist eine Mind Map über Buchhaltungsbücher und Buchhaltungsunterlagen.
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Internal Medicine-Gastroesophageal Reflux
definition
(gastroesophageal reflux disease, GERD), a disease caused by the reflux of gastroduodenal contents into the esophagus causing uncomfortable symptoms and/or complications
Reflux esophagitis (RE)
nonerosive reflux disease (NERD)
Pathogenesis
Gastroesophageal motility disorder mainly caused by LES (lower esophageal sphincter function) disorder. The main damage factors are reflux products such as gastric acid, pepsin, unconjugated bile salts, and pancreatic enzymes.
Antireflux barrier structural and functional abnormalities
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)
Reduced esophageal clearance
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
Impaired esophageal mucosal barrier function
Long-term smoking, drinking, eating irritating food or drugs
pathology
RE
Esophageal mucosal epithelial necrosis, inflammatory cell infiltration, mucosal erosion and ulcer formation
NERD
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
Barrett's esophagus - the squamous epithelium of the distal esophageal mucosa is replaced by metaplastic columnar epithelium
clinical manifestations
Esophageal symptoms
Typical symptoms
Reflux
The feeling of gastroduodenal contents pouring into the pharynx or mouth without nausea or exertion, A sour taste is called acid reflux
heartburn
Burning sensation behind the sternum or under the xiphoid process, often extending upward from the lower sternum
It usually occurs 1 hour after a meal, and can be aggravated when lying down, bending over, or when intra-abdominal pressure is increased, and can also occur during sleep at night.
atypical symptoms
chest pain
The reflux stimulation stimulates the esophagus. After the sternum, it can be strenuous, and it can be radiated to the front area, back, shoulders, necks, and ears, sometimes like angina pectoris
Dysphagia/retrosternal foreign body sensation
Esophageal spasm or dysfunction, intermittent
Partly caused by esophageal stenosis, which continues or progressively worsens
Extraesophageal symptoms
Refluxed material irritates or damages tissues or organs other than the esophagus, causing—— Chronic cough, pharyngitis, asthma, aspiration pneumonia, interstitial pulmonary fibrosis
complication
Barrett's esophagus
Precancerous lesions
Esophageal stricture
Recurrent esophagitis causes fibrous tissue hyperplasia, eventually leading to scar stenosis
upper gastrointestinal bleeding
Esophageal mucosal erosion and ulcers—vomiting blood and/or melena
Auxiliary inspection
Endoscopy
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.
Esophageal Reflux Testing
The “gold standard” for diagnosing GERD
Esophageal pH monitoring, Esophageal impedance-pH monitoring
Esophageal manometry
Preoperative evaluation for antireflux surgery
Barium esophagography
Helps rule out esophageal cancer and other esophageal diseases
diagnosis
Typical symptoms (reflux, heartburn) - after experimental treatment with PPI (proton pump inhibitor), if symptoms are significantly relieved - preliminary diagnosis of GRED
RE: ① Symptoms of heartburn and/or reflux; ② RE found under endoscopy
NERD: ① Symptoms of heartburn and/or reflux; ② Endoscopy is negative; ③ Esophageal reflux monitoring shows objective evidence of reflux; ④ PPI treatment is effective
Differential diagnosis
Differentiate from other esophageal lesions (such as infectious esophagitis, eosinophilic esophagitis, drug-induced esophagitis, achalasia, esophageal cancer, etc.), peptic ulcers, biliary tract diseases, etc.
The chest pain caused by it should be differentiated from cardiac chest pain and non-cardiac chest pain caused by other causes.
Differentiate with functional diseases such as functional heartburn, functional indigestion, etc.
treat
Control symptoms, heal mucosa, reduce recurrence, and prevent complications
patient education
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
Drug treatment
Acid suppressants
PPI: the first choice, with strong acid-suppressing effect and accurate curative effect. The treatment course is 4 to 8 weeks.
P-CAB (potassium ion competitive acid blocker): fast onset, long duration, precise effect at night, similar to PPI treatment course
H2 receptor antagonist: patients with mild to moderate symptoms, treatment course is 8 to 12 weeks
Gastrointestinal motility drugs
Increase LES pressure, improve esophageal peristalsis function, and promote gastric emptying
Mild patients, or as an adjunct to acid-suppressing drugs
antacids
Only used for temporary relief of symptoms in patients with mild symptoms and intermittent attacks.
Refractory GERD
No significant improvement in symptoms such as heartburn and/or reflux after 8 weeks of double-dose PPI therapy
Reasons related to reflux include: insufficient acid suppression, obesity, hiatal hernia, etc.
Causes unrelated to reflux include: esophageal motility disorder, other esophagitis, mental and psychological factors, etc.
Maintenance treatment
Treatment as needed - use when symptoms are present and discontinue when symptoms disappear, patients with NERD and mild esophagitis
Long-term treatment - rapid recurrence and persistence of symptoms after discontinuation of medication, severe esophagitis, esophageal stricture, Barrett's esophagus
PPI, P-CAB and H2RA can all be used for maintenance treatment, with PPI being the drug of choice
The dose varies from person to person, and it is appropriate to adjust it to the lowest dose that allows the patient to be asymptomatic.
Antireflux surgical 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
Treatment of complications
Barrett's esophagus
Maintenance treatment
Regular follow -up, find that severe hyperplasia or early esophageal cancer should be performed in time or surgery in time
Esophageal stricture
endoscopic esophageal dilation
long term maintenance treatment
Young patients may consider anti-reflux surgery
upper gastrointestinal bleeding
prognosis
Mild esophagitis (Grades LA-A and LA-B) – mucosal healing occurs after 4 weeks of treatment
Severe esophagitis (Grades LA-C and LA-D) – 8 weeks or more
prevention
Primary prevention is targeted at the general population and aims to prevent the occurrence of GERD, including popularizing disease prevention knowledge.
Secondary prevention targets high-risk groups and aims to identify GERD as early as possible and control its development, including regular community screening, etc.
Tertiary prevention is targeted at patient groups and aims to reduce the risk of complications and recurrence, including therapeutic life intervention, etc.