Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease ●​ GORD = Stomach content reflux to esophagus ○​ Chronic ○​ Throwback ●​ Weakness or dysfunction of lower esophageal sphincter ○​ LES ●​ Acidic gastric contents → irritation on esophageal lining → cause smx Path ●​ Lower esophageal sphincter → prevents stomach acid to move into esophagus In case of GORD 1.​ LES is weak/relaxed inappropriately 2.​ Gastric acid reflux into esophagus 3.​ Repeated exposure → esophageal irritation + inflammation 4.​ Chronic irritation → esophageal mucosa Lead to Esophagitis Risk ●​ Increase the risk in GORD ○​ Obesity ○​ ○​ Smoking ○​ Alcohol consumption ○​ Large meal + fatty food ○​ Hiatal hernia ●​ Other types of medication could worsen the reflux ○​ Amlodipine ■​ Calcium channel blocker ●​ Relaxes smooth muscle ●​ Lower esophageal sphincter relaxed ●​ Stomach acid will easily flow back into esophagus ■​ Used for hypertension and angina ○​ Nitroglycerin ■​ Smooth muscle relaxation ●​ Lower esophageal sphincter ■​ Barrier between stomach and esophagus is reduced ⇒ reflux is more easy to happen ■​ Used for Angina Pectoris ○​ NSAID ■​ Irritates gastric and esophageal mucosa ■​ Reduction of protective prostaglandin ●​ Esophagus is now more vulnerable on acidic damage ■​ Pain and inflammation related use ○​ Theophylline ■​ Cause relaxation to LES ■​ Increase in gastric acid secretion ■​ Used for asthma and chronic obstructive pulmonary disease Cx ●​ Heartburn ○​ Burning sensation in chest ●​ Acid regurgitation ●​ Sour taste in mouth ●​ Difficulty swallowing ○​ Dysphagia ●​ Chronic cough ●​ Hoarseness ●​ Chest pain ●​ Sour throat Smx might be worsen after meal/lying down