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CLINICAL PICTURES & PREDISPOSITION FACTORS

IN PATIENTS WITH EROSIVE AND NON EROSIVE


GASTROESOPHAGEAL REFLUX DISEASE

FARDAH AKIL

INTRODUCTION
Gastroesophageal reflux (GERD) is a disease with
heterogenicity feature, already known but usually is
annoyed
GERD appear if refluxate come into oesophagus with
enough amount and time so that could stimulate mucosa
symptoms w/out mucosal damages (esophagitis)
GERD have various of clinical symptoms, where
heartburn w/out regurgitation/reflux as spesific symptoms,
beside dyspepsia and extraesophageal symptoms

Based on upper endoscopy patients with heartburn or


GERD can subdivided into 2 catagories : those with or
without erosive esophagitis
Prevalence of GERD 21-44% on adult, male is equal with
female (gender analysis)
EGERD > with mild stage, male ~ female = 2-3:1
Patophysiology and pathogenesis
multifactorial, initially in esophagus,
junction, gastroduodenal & genetic

of GERD were
gastroesophageal

Progression of GERD is influenced by an interplay between


endogen and exogen factors
In Asia symptom of GERD not severe, just in NERD setting
Cohort analysis in Japan : mild EGERD to severe EGERD 10.5%,
Barrett oesophagus with predisposition factors : older age,
female, initial symptoms when diagnosed with endoscopy
examination, hiatal hernia , atropic gastritis & H.pylori infection
Limited data in Indonesia Syafruddin (1998) : esofagitis 22.8%
in dyspeptic patients

Capability of endoscopy to diagnose EGERD : high


sensitivity & specificity, to evaluate population prevalence
not common
GERD incidence is difficult to assess

PURPOSE
To determine the distribution of
endoscopic result, factor associated and
clinical variation of symptoms among
GERD patients undergoing upper
gastrointestinal endoscopy

SUBJECT AND METHODS

Study was conducted between 2000 November to


2004 October
Observational study with cross sectional approach involving dyspeptic patients in 2
teaching hospital in Makassar

All subjects were questioned in regard to clinical symptoms


before endoscopic examination
Diagnosis & classification of reflux esophagitis was based
on the LA Classification
Absence of reflux esophagitis with typical symptoms of
GERD was diagnosis as having NERD

Erosive and Non-erosive GERD were analysed


in relation to age, gender, and some of
predisposition factors : hiatus hernia, coffe
drinking, smoking and the used of NSAID

RESULT
Of 1290 dyspeptic patients, 540 (41.9%)
were diagnosed as having GERD based on
typical symptoms of GERD

Table 1.Characteristics of GERD patients

Tabel 2. Distribution of endoscopic results in GERD patients

* GERD = Gastroesophageal reflux disease, EGERD = Erosive GERD, NERD = Non erosive
reflux disease

Table 3. Distribution of GERD patients by gender

* GERD = Gastroesophageal reflux disease, EGERD = Erosive GERD, NERD = Non erosive
reflux disease; p < 0.050 significant

Table 4. Distribution of GERD patients by age

* GERD = Gastroesophageal reflux disease, EGERD = Erosive GERD, NERD = Non erosive
reflux disease; p > 0.05

60
50
40
NERD

30

EGERD

20
10
0
None

Bile reflux

Erosif

Ulcer

Gastric
cancer

Graphic 1. Findings of gastric lesions in GERD patients

Tabel 5. Predisposisition factors of GERD patients

EGERD = Erosive GERD, NERD = Non erosive reflux disease, NSAID = Non steroid anti inflammation drugs;
p > 0.050

Graphic 2. Symptoms pattern of GERD patients with reflux as a common


symptom

Graphic 3. Distribution of symptoms pattern of GERD patients

CONCLUSION

NERD constituted larger proportion and mostly


seen in female while EGERD was commonly in
male

Symptoms pattern between EGERD dan


NERD are identical

The findings of gastric lesions was found to


have relationship with GERD symptom

EGERD in patients with GERD in


Makassar was found higher and majority
case was grade A & B
Some of predisposition factors in this
study are not associated in the severity of
GERD