Gastroesophageal Reflux Disease (GERD)

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Gastroesophageal Reflux Disease (GERD)
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• Definition inflammation of the lower part of
  the esophagus due to abnormal reflux of gastric
  contents into the esophagus
• Often chronic and relapsing

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• GERD is due to weakness of the lower esophageal
  sphincter (LES) leading to reflux of the acidic
  gastric content to the lower part of the
  esophagus.

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Risk factors - Obesity- Sliding Hiatal
hernia- Pregnancy- Smoking- Delayed stomach
emptying- Connective tissue disorders, such as
scleroderma- Alcoholism.
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Clinical Manifestations

• 1. Heartburn retrosternal burning discomfort.
• 2. Regurgitation effortless return of gastric
  contents into the pharynx without nausea, or
  abdominal contractions. To be differentiated from
  vomiting.
• 3. Dysphagia difficulty in swallowing
• 4. Extra-esophageal manifestations laryngitis,
  chronic cough

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Morphological features of GERD

• Grossly the lower part of the esophagus is
  red, and may shows erosions.

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• Microscopically
• 1. Inflammatory cellular infiltrate in the
  squamous epithelium including neutrophils,
  esinophils and lymphocytes.
• 2. Basal cell hyperplasia.
• 3. Acute inflammation of the sub epithelium
  (lamina propria)

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Esophagogastrodudenoscopy
Investigations

• Indications (with biopsy if needed)
• In patients with alarm signs/symptoms
• Those who fail a medication trial
• Those who require long-term treatment.

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Complications of GERD

• Erosive esophagitis
• Stricture of esophagus due to healing by
  fibrosis.
• Barretts esophagus

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• Erosive esophagitis
• Responsible for 40-60 of GERD symptoms

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• Esophageal stricture
• Result of healing of erosive esophagitis
• May need dilatation

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• Barretts Esophagus
• Transformation of the stratified squamous
  epithelium of the lower end of the esophagus into
  intestinal epithelium (glandular metaplasia).
• The clinical significance of Barretts Esophagus
  is that it is associated with the development of
  dysplasia and subsequently adenocarcinoma.

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References Robbins and Cotrans Pathologic
Basis of Disease. Seventh edition.