View Full Version : Gastro-oesophageal Reflux Disease (Aetiology-Pathology-Investigations-Clinical Picture-Treatment)

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04-21-2008, 11:26 AM
Loss of competence of lower oesophageal sphincter either with or without sliding hiatus hernia.
A degree of reflux is normal particulaely after heavy meal. (physiological reflux)
Reflux of the gastric content to the lower oesophagus leads to its hyperaemia and inflammation and ultimately ulceration. Healing of the ulcers by fibrosis may cause narrowing and shortening of the oesophagus.
Clinical Picture:
1. Fatty dyspepsia is more common in GORD than in gall stone disease.
2. Retrosternal burning sensation (heart burn) provoked by food.
3. Reflux of food to the mouth in severe cases especially during lying flat.
4. Odynophagia with hot, citrus or alcohol drinks.
5. Atypical presentation like angina like chest pain make diagnosis difficult
6. Dysphagia is usually a sign of stricture or due to associated motility disorder.
In the majority of cases the diagnosis is assumed rather than proven and the treatment is empirical.
1. Endoscopy, to show lower oesohagitis or stricture or to diagnose hiatus hernia.
2. 24 hours PH monitoring with oesophageal manometry to exclude achalasia as a cause of hyperacidity as accumulated fluid may ferment and produce lactic acid.
3. Barium swallow and meal: are needed to delinate the GO junction during planning for operation.
Most of cases respond to medical measures. It is the same measure to treat hyperacidity. Many surgical antireflux techniques were described but the choice now lies between either total or partial fundoplication.
The laparoscopic fundoplication reduces the postoperative morbidity and the the hospital stay.
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