Oleh : Fina Khairunnisa

DIAGNOSIS AND TREATMENT OF

GASTROESOPHAGEAL REFLUX
DISEASE
Dokter Pembimbing : dr. Arif
 Definition

Gastroesophageal reflux disease (GERD) is defined as

symptoms or mucosal damage produced by the
abnormal reflux of gastric contents into the esophagus
or beyond, into the oral cavity (including larynx) or
lung causes troublesome symptoms and/or
complication.
 Epidemiology

In Western populations, GERD affects

approximately 10% to 20%, Compared to a preva-
lence of less than 5% in Asia. The prevalence rate
of GERD in developed nations is also tightly
linked with age, with adults aged 60 to 70 being
the most commonly affected.
 Symptoms Of GERD
Definition

Heartburn

Typical

Acid Regurgitation
 Symptoms Of GERD

» Dysphagia, odynophagia
» Nausea
Atypical » Chest pain
» Dyspepsia

» Chronic cough
Extraesophageal » Hoarseness, laryngitis
» Vocal Cord Dysfunction, Bronchospasm
 Dysphagia/odynophagia

Nausea/Vomiting

Melena
Alarm
Symptoms
Extended duration of symptoms

Family history of PUD

No response to PPI
 Diagnostic Testing for gastroesophageal reflux disease

Diagnostic Test Indication

PPI trial Classic GERD symptoms with no alarm

symptoms.

Esophageal pH monitoring Refractory symptoms where GERD diagnosis is

in question, pre-operative evaluation for non-
erosive disease

Upper endoscopy Alarm symptoms (e.g., dysphagia), PPI

unresponsive patients, high risk for Barrett’s
esophagus

Esophageal manometry Prior to anti-reflux surgery to rule out esophageal

dysmotility (e.g., achalasia, scleroderma),
otherwise not recommended for GERD evaluation
 Treatment goal for GERD

Eliminate symptoms

Manage or prevent complication

Maintain remission

Lifestyle modification
 Elevate head of bed 4-6
inches

Avoid eating within 2-3 hours

of bedtime
Lifestyle
modification
Lose weight if overweight

Modify diet
Medical Therapy
 Surgical Therapy

• Unwillingness to remain on lifelong medical

therapy
• Intolerance of medical therapy
• Medically refractory symptoms with objective
evidence of GERD
• GERD in the setting of a large hiatal hernia
Medically refractory GERD in the setting of
morbid obesity
 Complications of GERD

• Peptic stricture
• Metaplastic disease (Barrett’s)
• Dysplastic disease (adenocarcinoma)
• Laryngitis
• Pulmonary disease
 Articles
• Badillo R, Francis D. Diagnosis and treatment of gastroesophageal
reflux disease. World Journal of Gastrointestinal Pharmacology and
Therapeutics 2014; 5(3):105-112. doi: 10.4292/wjgpt.v5.i3.105.
• Achem SR, DeVault KR. Gastroesophageal reflux disease and the
elderly. Gastroenterol Clin North Am. 2014 Mar; 43(1):147-60. doi:
10.1016/j.gtc.2013.11.004. Review. PubMed PMID: 24503365
• Vela MF. Medical treatments of GERD: the old and new.
Gastroenterol Clin North Am. 2014 Mar; 43(1):121-33. doi:
10.1016/j.gtc.2013.12.001. Epub 2013 Dec 31. Review. PubMed
PMID: 24503363
• Overland MK. Dyspepsia. Med Clin North Am. 2014 May; 98(3):549-
64. doi: 10.1016/j.mcna.2014.01.007. Epub 2014 Mar 18. Review.
PubMed PMID: 24758960