复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）消化系统_GERD

复旦大学附属中山医院 Zhongshan Hospital, Fudan University Gastroesophageal reflux disease (GERD Gao Hong Department of Gastroenterology Zhongshan Hospital Fudan University www.zshospital.com

www.zshospital.com Gastroesophageal reflux disease (GERD) Gao Hong Department of Gastroenterology Zhongshan Hospital Fudan University

复旦大学附属中山医院 Zhongshan Hosp Fudan University Outline Definition and classification Pathogenesis Pathology · Manifestation Diagnostic approach Diagnosis and differentiation diagnosis · Treatment Key points Q&A www.zshospital.com

www.zshospital.com Outline • Treatment • Key points • Q & A • Definition and classification • Pathogenesis • Pathology • Manifestation • Diagnosis and differentiation diagnosis • Diagnostic approach

复旦大学附属中山医院 Zhongshan Hospital Fudan University Definition GERD is a condition which develops when the reflux of stomach contents causes troublesome symptoms andlor complications. The Montreal Definition and Classification of Gastroesophageal Reflux Disease Am j gastroenterol 2006: 101: 1900-1920 www.zshospital.com

www.zshospital.com Definition • GERD is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The Montreal Definition and Classification of Gastroesophageal Reflux Disease Am J Gastroenterol 2006;101:1900–1920

复旦大学附属中山医院 Zhongshan Hospital, Fudan University Prevalence of GER symptoms 8.97% 25-38% 10.3% 20-40% 17% www.zshospital.com

www.zshospital.com Prevalence of GER symptoms 10.3% 20-40% 25－38% 8.97% 17％

复旦大学附属中山医院 Zhongshan Hospital, Fudan University Prevalence of GER symptoms in China Harbin Dunhuang Beijing 10.19% e111r (XIan 16.9% xian Shanghai776% 发 shangha1 La吕a chengdu mre rges Guilin ong Kong Haiko www.zshospital.com

www.zshospital.com Beijing10.19% Xi’an 16.9% Shanghai7.76% Prevalence of GER symptoms in China

复旦大学附属中山医院 Zhongshan Hospital, Fudan University Iceberg Phenomenon visit doctor 18. 62% 0TC27.24% Others 54. 4% www.zshospital.com

www.zshospital.com Iceberg Phenomenon Others 54.4% OTC 27.24% visit doctor 18.62%

复旦大学附属中山医院 Zhongshan Hospital, Fudan University GERD Classification 1. Reflux esophagitis 2. Non-erosive reflux disease( NerD) 3. Barrett Esophagus

www.zshospital.com GERD Classification 1. Reflux esophagitis 2. Non-erosive reflux disease(NERD) 3. Barrett Esophagus

Gastroesophageal reflux(GER) Gastric acid(ph 1.5-2.0 )- Esophogus(ph 6.0-7.0) Physiological Pathological ● after mea frequent ● short period long period ● seldom at night oin the daytime and or at night seldom causes symptoms .can cause symptoms and/or esophageal lesion 究置 AcID ACID www.zshospital.com

www.zshospital.com Physiological •after meal •short period •seldom at night •seldom causes symptoms •frequent •long period •in the daytime and/or at night •can cause symptoms and/or esophageal lesion Pathological Gastric acid (pH 1.5-2.0) Esophogus(pH 6.0-7.0) Gastroesophageal reflux (GER)

Pathogenesis Defense from reflux UES Anti-reflux barrier: LES, Diaphragm Esophagus scavenging: peristalsis, saliva Aorta left main Esophageal mucosa t bronchus Damage to esophagus Esophagus Incompetent barrier-tLESR LES Diaphragm Gastric contents www.zshospital.com

www.zshospital.com Pathogenesis Defense from reflux Anti-reflux barrier: LES, Diaphragm Esophagus scavenging : peristalsis, saliva Esophageal mucosa Damage to esophagus Incompetent barrier-tLESR Gastric contents UES Aorta left main bronchus Esophagus LES Diaphragm

Pathogenesis Esophagitis Inflammation Normal caused by esophagus acid in LOW stomach Esophageal Barretts Sphincter esophagus: Acid backing up from stomach changes Diaphragm esophagus lining Hiatal hernia: Stomach Diaphragm bulging above diaphrag Pancreatic enzyme

www.zshospital.com Pathogenesis HCl Pepsin Bile Pancreatic enzyme Low Esophageal Sphincter