VAAGDEVI PHAMACY COLLEGE

Presentation on Gastroesophageal reflux disease

Alli Hyndavi

20ED1T0002

PHARM .D 3rd year

PHARAMACOTHERAPEUTICS II
 GASTROESAPAGEAL REFLUX DISEASE
INTRODUCTION

Gastroesophageal reflux disease is mainly a clinical diagnosis based on typical

symptoms

Of heart burn and acid regurgitation .

DEFINATIO
N
Gastroesophageal reflux disease is a common disease, account more than 5.6 million people.
It occurs when the stomach contents flow back upto the esophagus . the muscular tube that
carries food and liquids from the mouth to the stomach.
GERD is also called acid reflux regurgation because the stomach digestive juices contain
acid Occasionally GERD is common in people and may control by;
1.Avoiding foods and beverages that contribute to heart burn ,such as chocolate
,juice,pepperment,greasy,
Spicy foods ,tomato products and alcoholic
beverages. 2.Over eating
3. loosing weight (if obese).
4.not eating 2 to 3 hrs before
sleep. 5.quiting smoking.
6.taking medications.

Other factors -obesity

Pregnancy
Certain
medications
Epidemiology:
GERD is common ,accounting for more than 6 million population in a year
From 10% TO 20% of adults in western countries and nearly 5% of those in asia experience GERD
symptoms As much as 16% of the population complains of regurgitation ,and 6% report clinically
troublesome heartburn
Etiology:
Genetic :
Acid reflux is genetic ,this means that multiple family members have more likely to have the
condition . GERD have identical common markers in our DNA associated with the acid reflux
Environmental cause:
1le modifications +6666.Obesity
2.life style modifications and dietary like -alcohols and lots of sugar consumption and
choices intake fat
2.smoking
3. bending or lyimg down causes heart burn
Drugs :antibiotics
Bisphosphates(Albendazole ,ibandazole,Risedronate)
Iron supplements
Qunidine
Pain relievers
Potassium
supplements
1.Antibiotics : they cause irritation to the lininning of the stomach causes secrete more
acid 2.Bisphosphates :it causes the upper gastrointestinal mucosal injury .
3.Iron supplements : they cause the esophageal and causes heart burn.
3.Pain relievers : they increase the production of the acid in the
stomach . Mi cro organisms:1.Helicobacter pylori ,but still it is not
clear .

4.Symptoms:
The main symptom is Heart burn though some of the adults have no heart
burn Other symptoms include :
-dry cough
-wheezing
-nausea
-vomiting
Swelling and irritation of the voice
box Dental erosion
Bad breathe
Difficulty in swallowing

PATHOPHYSIOLOGY:
Transient lower esophageal sphincture relaxation
|
Sliding hiatal hernia
|
Low LES pressure
|
Acid pocket development due to poor
mixing Of acid with chyme in the proximal
stomach
|
Increased gastro esophageal junction
|
Delayed gastric emptying
DEFFERNTIAL DIAGNOSIS:

GERD is mainly a clinical diagnosis based on typical symptoms :

-upper endoscopy
-esophageal pH monitoring
-esophageal manometry

ESOPHAGEAL MANOMETRY :
It is the second line treatment forr the diagnosis of GERD .Detection
of achalasia is critical if the patient having surgery.
It shows weather your esophagus is working properly .it is aswalloing
test . A cather is inserted through the nose down the esophagus to
stomach .you will be asked to lie down on your left side.the tube is
connected to the machine that records the pressure that is placed on the
tube.
This tests lasts for 10-12 min
UPPER ENDOSCOPY :
It is used to determine the heart burn .it has thin scope with a light
and camera at its tip to look inside the digestive system .
3.Esophageal pH test :
It measures the stomach acid that enters the esophagus the tube that called pH probe into
esophagus It will measures the acid levels in the stomach for 24 hrs to 96hrs.

4.BIOPSY;
Although this examine is very accurate we will take biopsies from the esophagus to confirm the
diagnosis As well as look for the precancerous change of dysplasia that cannot be seen though
endoscopy .
RELATED HEALTH CONDITIONS:

1. HIATAL HERNIA:

A condition in which part of the stomach pushes up through the diaphram

muscle Symptoms :1.heartburn
2,chestpain
3.hiccup
2. IRRITABLE BOWEL
SYNDROME :
An intestinal disored
causing pain in the
stomach ,wind,diahheea ,an
d constipation.
Symptoms :changes in bowel
habits
Symptoms
alleviated by de
 Management :
Life style changes :

Some of people can reduce GERD symptoms:

-losing weight ,if needed
-waering loose fitting clothes around the stomach
-reamining upright for 3hrs after meals
-rasing the head upto 6 to 8 inches by wearinig wool clothes .
-avioding smoking .

MEDICATIONS:
1.ANTACIDS:
The important of histamine in stimulating parietal cell activity ,neutralisitation
of secreted acid antacids constituted the main form of therapy for peptic
ulcers.
If ever ,used as the primary therapeutic agent but instead are often used by
patients for symptomatic relief of dyspensia .
Most commonly used agents are mixtures of aluminium hydroxide and
magnesium hydroxide causes loose stools
Many of the commonly used antacids (Aluminium hydroxide ,calcium carbonate
,magnesium trisilicate,maalox,gaviscon,gelusil,riopan,tums)
Side effects : diarrhea
Constipation
Nausea
Headache
Note: on longterm usage
Dosage : 2-4 chewable
tablets,OD .

2.Prokinetics :
Prokinetic agents or prokinetics are the medications that help to
control acid reflux .
,enhance peristalasis.,strengthen the lower esophageal sphincture
(LES) and cause contains of the stomach to empty faster.
Ex: Bethanechol(Urecholine)-10-50mg QID
Metoclopramide(Reglan)-10mg QID

3.Antibiotics:
Antibiotics has motilin like effect on the stomach and significantly
increases the lower esophageal sphincter preesure in normal
volunters.
Ex: Erythromycin -250mg TID
Side effects : rash
Dizziness

Diarrhea
Yeast
infections
4. Proton pump
inhibitors :
These are effectively block gastric acid secretion by irreversibly binding to and inhibiting the
hydrogen potassium ATPase pump that resides on the luminal surface of the parietal cell
membrane .
Ex: Dexlansoprazole (dexilant) -30mg OD
Esmoprazole (mexium) -20mg OD
Lansoprazole(prevalacid ) 30mg OD
Omeprazole (prilosec) -30mg OD
Pantaprazole(protinix) -40mg OD

5. H2 receptor antagonist :
Decrease the gastric acid secretion by reversibly binding histamine H2 receptor located on the
gastric parietal cells thereby inhibiting the binding and activity of the endogenous ligand
histamine(H2 blockers thus function as competitive antagonist)
ex:Cimetidine -200mg BD
SIDE EFFECTS :fatige
Constipation
Muscleaches
CASE PRESENTATION :

DEMOGRAPHICS:

NAME:XYZ
AGE:60yrs
SEX: male
DOA:2.12.2022
IP.NO:65746
DEPARTMENT:General medicine
CONSULTANT PHYSICIAN:Dr.Naveen
CASE PRESENTATION:
SUBJECTIVE FINDINGS:

A 60 yrs old patient was admitted in hospital with the complaints of

c/o abdomianal discomfort for 10days

HISTORY OF PRESENT ILLNESS:

H/O: Abdominal discomfort

Difficulty in breathing
Skin allergy
Cough with expectorations

PAST HISTORY :

K/C : Bronchial asthma

before 3days
OBJECTIVE FINDINGS :
ESR:shows increased value
CBP:it shows increased WBC
URINE ANALYSIS :it shows
pale yellow coloured ,acidic.
ASSESSMENT:

Based 0n the subjective and objective findings the current

conditions is diagnosed with GERD with asthma.
SYSTEMIC EXAMINATION :

CVS:S1,S2+VE

RS:B/L AE+VE ,B/L +VE

CNS:

P/A:Soft
OTHER INVESTIGATIONS:

X-RAY:

Increased Bronchovascular markings.

UGI ENDOSCOPY :

IMPRESSIONS:some inflammation in the esophagus.

Monitoring parameter:

pH MONITORING for GERD:

Increased acid exposure time.

THANK YOU