Acne Vulgaris definition, causes, aggravating factors, pathogenesis, classification, complications, treatment and management.

 

Gastroesophageal reflux disease “GERD”

Definition

GERD is the backward movement of the gastric contents to the esophagus.

 

 

Factors that regulate the movement of food from esophagus to stomach:

• Circular and oblique muscles of musculosa of stomach (control of the esophageal sphincter diameter).
• Gravity (downward movement of the food from the top to the bottom).
• Pressure difference between esophagus and stomach (diaphragm separate between abdominal and thoracic regions to maintain pressure difference, abdominal pressure is lower than thoracic pressure).
• Acute angle of the lower esophageal sphincter (acute angle prevent the backward movement of the food to the esophagus).
  

Agents that may cause food reflux

• Full meals (when the stomach is fully filled, reflux becomes easier).
• Fatty meals, Coffee, tea, Chocolate and heavy smoking (these agents decrease lower sphincter tone). 
•  Obesity (increase intraabodminal pressure, which facilitates acid reflux).
• Pregnancy.
• Hiatal hernia (means that stomach is in the thoracic region, which results in equal Pressure between esophagus and stomach).
  
• Organomegali (which increase intraabodminal pressure).

Symptoms of GERD

The most common symptom of GERD is heartburn within 1 hour of meal.

Diagnosis of GERD

• Clinical picture (heartburn sensation after meal).
• Esophageoscopy.
• PH monitoring.

Treatment and management of GERD

Patient counseling

• Eat alkaline food.
• Avoid heavy meals, fatty meals, coffee, tea, chocolate.
• Avoid smoking.
• Upright sitting after meal.
• Avoid bending after meal.

Pharmacological treatment of GERD

PPIs or H2 blockers at least 30 minutes before meal or antiacids after meal.

 

GERD in asthmatic patients

GERD patients experience worsening of asthma and vice versa.

How GERD worsen asthma?

Acid reflux to the airway could induce asthma attacks (acid induced asthma).

How asthma worsen GERD?

Cough, deeply and difficultly breathing press on the diaphragm, then diaphragm press on the stomach which leads to stomach content reflux.

Complications of GERD

The most serious complication of GERD is “Barrett esophagus“.

 

Barrett esophagus is the metaplasia of squamous epithelial cells of the esophagus to columnar epithelial cells (which is more resistant to acid) due to chronic acid exposure.

 

GERD in pregnancy

Causes of GERD in pregnancy

At the beginning of pregnancy, estrogen and progestin levels are high (they have a relaxing effect on lower esophageal sphincter), which facilitates stomach contents reflux to the esophagus.

 At the last periods of pregnancy, the fetus press on the abdomen (which increase intraabdominal pressure, thus facilitates stomach contents reflux to the esophagus).

GERD in children

Why GERD occur in infants less than 6 months and relives after 6 months of birth?

• Because infants less than 6 months yet has not fully matured lower esophageal sphincter. 
• Because infants at this age are sleeping most of the time (sleeping or bending equalize abdomimal and thoracic pressures so reflux becomes easier).
• Before 6 months they eat only soft food (mainly milk), which is easy to reflux.

Symptoms of GERD in children

• Heartburn.
• Inconsolable crying.
• Early satiety.
• Aching of his back.
• Tilting of the head to one side.

Management of GERD in children

• Thickening of the food.
• Keep child upright.
• Rising the head of the bed.
• Antiacids also can be used.