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MindMap Gallery Internal Medicine Digestive System-Gastroesophageal Reflux Disease

Internal Medicine Digestive System-Gastroesophageal Reflux Disease

Internal Medicine Digestive System - Gastroesophageal Reflux Disease Mind Map, which introduces the causes, clinical manifestations, diagnosis, differential diagnosis, and treatment of GERD. If you need it, collect it quickly!

Edited at 2024-04-01 14:38:50

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Internal Medicine Digestive System-Gastroesophageal Reflux Disease

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Outline

Gastroesophageal Reflux Disease GERD Gastroesophageal reflux disease

1. Overview

: It is a disease that causes uncomfortable symptoms and/or complications caused by the reflux of gastroduodenal contents into the esophagus.

Classification

①Reflux esophagitis RE (reflux esophagitis)

②Nonerosive reflux disease NERD (nonerosive reflux disease)

2. Etiology and pathogenesis

1. Abnormal structure and function of anti-reflux barrier

①Achalasia surgery, hiatal hernia

②Increased intra-abdominal pressure (pregnancy, obesity, abdominal effusion, constipation, etc.)

③Long-term increase in intragastric pressure (delayed gastric emptying, gastric dilation, etc.)

Structural and functional abnormalities

④Certain hormones (cholecystokinin, glucagon, vasoactive intestinal peptide)

⑤Food (high fat, chocolate, etc.)

⑥Drugs (CCB, diazepam)

2. Reduced esophageal clearance

Sjogren's syndrome, hiatal hernia

3. Reduced esophageal mucosal barrier function

Long-term drinking, smoking, irritating food or drugs.

3. clinical manifestations

(1) Esophageal symptoms

①Typical symptoms

Reflux and heartburn are the most common, often occurring 1 hour after a meal, and are aggravated when lying down, bending over, or with increased intra-abdominal pressure.

Reflux: The feeling of gastroduodenal contents pouring into the pharynx or mouth without nausea or straining. Heartburn: A burning sensation behind the breastbone or under the xiphoid process.

②Atypical symptoms

Substernal pain, difficulty swallowing, or a foreign body sensation under the sternal bone.

(2) Extraesophageal symptoms

Caused by reflux material irritating or damaging tissues or organs other than the esophagus.

Dental erosion, pharyngitis, chronic cough, asthma, aspiration pneumonia, pulmonary interstitial fibrosis, globus hysteria.

(3) Complications

①Upper gastrointestinal bleeding: vomiting blood, melena, etc.

② Esophageal stenosis

③Barrett’s esophagus

Normal esophageal mucosa is stratified squamous epithelium, which is uniformly pink under gastroscopy. When it is replaced by metaplastic columnar epithelium, it turns orange. It is mostly located at the proximal end of the dentate line at the gastroesophageal junction. When it is ring-shaped, tongue-shaped or island-shaped, If the lesion is ≥1cm, Barrett's esophagus should be considered.

4. Auxiliary inspection

(1) Gastroscopy

The most accurate way to diagnose RE.

RE Los Angeles Rating: Normal: there is no damage to the esophageal mucosa; Grade A: one or more esophageal mucosa is damaged, and the long diameter is <5mm; Grade B: one or more esophageal mucosa is damaged, the long diameter is >5mm, but there is no fusion; Grade C: The esophageal mucosa is damaged and fused, but <75% of the esophageal circumference; Grade D: The esophageal mucosa is damaged and fused, involving at least 75% of the esophageal circumference.

(2) 24h esophageal pH monitoring

(3) Barium esophagography

(4) Esophageal manometry

5. diagnosis

PPI experimental treatment: Patients with typical reflux and heartburn symptoms were treated with PPI (omeprazole 20 mg each time, twice a day, for 7-14 days), and their symptoms were significantly relieved. →Initial diagnosis of GERD.

RE diagnosis

①Have symptoms of reflux and/or heartburn; ②RE was found under gastroscopy.

NERD diagnosis

①Have symptoms of reflux and/or heartburn; ②Gastroscopy is negative; ③24h esophageal pH monitoring shows excessive acid and alkali reflux in the esophagus; ④PPI treatment is effective.

6. Differential diagnosis

① Other esophageal diseases (infectious esophagitis, eosinophilic esophagitis, drug-induced esophagitis, achalasia, esophageal cancer.)

②Peptic ulcer (chronic, cyclical, rhythmic, upper abdominal pain, other complications, gastroscopy identification.)

③Biliary tract diseases (cholelithiasis, cholecystitis, cholangitis, etc.)

④ Chest pain VS cardiac chest pain and non-cardiac chest pain

⑤Functional diseases (functional indigestion, functional heartburn, etc.)

7. treat

Purpose: To control symptoms, cure esophagitis, reduce recurrence and prevent complications.

(1) Drug treatment

①Acid-suppressing drugs: PPI (preferred, 4-8w) and H2RA (8-12w)

②Gastrointestinal motility drugs: domperidone, mosapride, itopride.

③Antacids: bismuth, weakly alkaline antacids

④Refractory GERD: After 8 weeks of treatment with standard-dose PPI, there is no significant improvement in reflux and/or heartburn symptoms.

⑤Long-term treatment: Symptoms relapse quickly and persist after drug withdrawal, severe esophagitis, esophageal stenosis, and Barrett's esophagus.

(2) Patient education

①Patients with damaged LES structure or abnormal function should not stay in bed immediately after eating or eat within 2 hours before going to bed. The head of the bed can be raised by 15~20cm while sleeping.

② Reduce factors that cause increased intra-abdominal pressure, such as constipation, obesity, tight belts, etc.; avoid eating foods that reduce LES pressure, such as high fat, chocolate, coffee, strong tea, etc.; use drugs and medications that reduce LES pressure with caution Drugs that cause delayed gastric emptying, such as nitroglycerin, calcium channel blockers, anticholinergic drugs, etc.

③No smoking or drinking.

(3) Anti-reflux surgical treatment

laparoscopic fundoplication

(4) Treatment of complications

①Upper gastrointestinal bleeding: See the chapter on gastrointestinal bleeding

② Esophageal stenosis

Endoscopic esophageal dilation PPI, surgical treatment (severe scar stenosis)

③Barrett’s esophagus

PPI gastroscopy regular follow-up

There is a tendency for malignant transformation into adenocarcinoma.

Endoscopic or surgical treatment as soon as possible

Retest short answer questions: 1. What are the two types of GERD? 2. What is the mechanism of gastroesophageal reflux disease? 3. What are the clinical manifestations of reflux esophagitis? complication? 4. What is the Los Angeles classification of reflux esophagitis? 5. Treatment of gastroesophageal reflux disease?

Causes: Insufficient acid suppression, weak acid/alkali reflux, esophageal hypersensitivity, obesity, hiatal hernia; esophageal motility disorder, other esophagitis, etc.

Globus hysteria: The patient complains of pharyngeal discomfort, foreign body sensation or blockage sensation, but no dysphagia.