Gastroesophageal reflux disease (GERD)

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Gastroesophageal reflux disease (GERD)

Normal pH range in Stomach is 1-4
Normal pH range in Oesophagus is 5-7
Thus regurgitation of acidic content is harmful to oesophagus.

Normal protective mechanisms :

• LES (lower esophageal sphincter - pressure 20-25 mmHg)
• Oesophageal motility

Minor protective mechanisms :

• Mucosal folds
• Angle of  "His"
• RIGHT Crus of diaphragm

Presentation :

• Heart burn
• Water brash (if into mouth)

Investigations for GERD :

1. 24 hr pH monnitoring (IOC)
2. Manometry (Screening method of choice)
3. Endoscopy and barium studies have also been used.
4. Bernstein test (Obsolete)

Treatment : 

• Medical - PPI (Proton pump inhibitors)

• Surgery - Same as for hiatus hernia (i.e Fundoplication , Hill's repair)

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