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    Konsensus GERD PGI PDF

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    Mirza Zaka
    This document summarizes the key points of a consensus on Gastroesophageal Reflux Disease (GERD) in Indonesia. It defines GERD and its common symptoms. It discusses the increasing prevalence of GERD and need to revise diagnosis and management. Diagnostic tests like pH monitoring are outlined but no single test is definitive. Proton pump inhibitors are first-line treatment but some patients remain refractory. Surgery is an option for refractory cases and newer minimally invasive procedures are being developed.

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    Konsensus GERD PGI PDF

    Uploaded by

    Mirza Zaka
    571 views44 pages
    This document summarizes the key points of a consensus on Gastroesophageal Reflux Disease (GERD) in Indonesia. It defines GERD and its common symptoms. It discusses the increasing prevalence of GERD and need to revise diagnosis and management. Diagnostic tests like pH monitoring are outlined but no single test is definitive. Proton pump inhibitors are first-line treatment but some patients remain refractory. Surgery is an option for refractory cases and newer minimally invasive procedures are being developed.

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    This document summarizes the key points of a consensus on Gastroesophageal Reflux Disease (GERD) in Indonesia. It defines GERD and its common symptoms. It discusses the increasing prevalence of GERD and need to revise diagnosis and management. Diagnostic tests like pH monitoring are outlined but no single test is definitive. Proton pump inhibitors are first-line treatment but some patients remain refractory. Surgery is an option for refractory cases and newer minimally invasive procedures are being developed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    571 views44 pages

    Konsensus GERD PGI PDF

    Uploaded by

    Mirza Zaka
    This document summarizes the key points of a consensus on Gastroesophageal Reflux Disease (GERD) in Indonesia. It defines GERD and its common symptoms. It discusses the increasing prevalence of GERD and need to revise diagnosis and management. Diagnostic tests like pH monitoring are outlined but no single test is definitive. Proton pump inhibitors are first-line treatment but some patients remain refractory. Surgery is an option for refractory cases and newer minimally invasive procedures are being developed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 44
    At a glance
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    The key takeaways are that GERD is a common condition caused by reflux of stomach contents into the esophagus, leading to symptoms like heartburn. Risk factors include age, sex, obesity, smoking, and family history. Diagnosis involves evaluating symptoms and ruling out other potential causes through tests.

    The main symptoms of GERD mentioned are heartburn, chest pain, regurgitation, dysphagia, and odynophagia. These symptoms can overlap with those of dyspepsia.

    Factors associated with increased risk of GERD mentioned are older age, male sex, certain races, family history, higher socioeconomic status, higher BMI, and smoking.

    Konsensus Gastro Esophageal Reflux

    Disease (GERD)
    Perkumpulan Gastroenterologi Indonesia
    (PGI)
    Dr. Tjahjadi Robert Tedjasaputra SpPD, KGEH, FINASIM
    Jakarta 10 Mei 2014

    Masalah:
    Kasus & komplikasi meningkat
    Perbedaan prevalensi & manifestasi klinis
    Teknologi diagnostik
    Kemampuan diagnosis & penatalaksanaan
    Revisi konsensus

    Definisi : Gangguan (kualitas hidup) akibat


    refluk berulang isi lambung ke esofagus.
    Gejala: Heartburn, Nyeri dada nonkardiak
    Regurgitasi,
    Disfagia,
    Odinofagia
    Tumpang tindih dengan dispepsia
    Gejala THT, Saluran nafas, Gigi & mulut

    !Patients

    do not reliably
    interpret the word
    heartburn
    !For symptom evaluation, a
    burning feeling rising from
    the stomach or lower chest
    up toward the neck is
    more reliable than
    heartburn
    Carlsson et al. Scand J Gastroenterol. 1998;33:1023-1029.

    From Vakil N et al. Am J Gastroenterol 2006;101:1900-20.

    Epidemiologi:
    Barat 10-20%, Asia 3-5 %, Jepang: 13-15 % , IND
    13 %
    usia lanjut, pria, ras, riwayat keluarga, ekonomi
    tinggi, IMT tinggi, dan merokok.

    Patofisiologi:
    - Kontak refluksat & mukosa esofagus
    - Penurunan resistensi esofagus
    - Gangguan sensitifitas persepsi sentral/perifer
    mukosa esofagus
    - Potensi perusak: as. Lambung, pepsin, garam
    empedu, ensim pankreas.

    Peranan motilitas, Helicobacter pylori, peranan


    kebiasaan/gaya hidup, dan hipersensitivitas
    visceral.
    H Pylori: Cag A positif
    Kebiasaan hidup: Rokok & IMT, Alkohol & Psikis,
    Obat2an : e.g. Bronkodilator
    Peran motilitas: TLESR (Transien Lower
    Esophageal Sphincter Relaxation), disfungsi
    LES, bersihan esofagus & pengosongan
    lambung.
    Hipersensitifitas viceral: persepsi perifer &
    sentral.

    There is no single
    diagnostic gold
    standard for GERD

    Diagnosis:
    Anamnesis: GERD Q
    Penunjang menyingkirkan diagnosis:
    laboratorium, EKG, USG, foto toraks, dan
    lainnya sesuai indikasi).

    !Coronary

    artery disease
    !Gallstones
    !Gastric /esophageal cancer
    !Peptic ulcer disease
    !Esophageal motility disorders
    !Pill induced esophagitis
    !Eosinophilic esophagitis
    From Kahrilas PJ. N Engl J Med 2008;359:1700-7.

    !Empiric

    trial
    !Barium esophagram
    !Endoscopy
    !Manometry
    !pH testing
    !Impedance

    !GERD

    despite therapy
    !Dysphagia
    !Odynophagia
    !GI bleeding/anemia
    !Mass, stricture or ulcer on imaging
    study
    !Recurrent symptoms after antireflux
    surgery
    From Gastrointest Endosc 2007;66:219-24.

    !Screening

    for Barretts in
    selected patients
    !Persistent vomiting
    !Suspected extraesophageal
    GERD

    From Gastrointest Endosc 2007;66:219-24.

    Pembagian endoskopis: ERD & NERD


    GERD Refrakter: Tidak respon PPI 4-8
    minggu
    NAR (Non acid reflux): Cairan empedu/
    asam lemah/alkali/ gas ! Manometri,
    Impedans, Bilitec
    Komplikasi: Barretts esophagus,
    Adenocarcinoma

    From Kahrilas PJ. N Engl J Med 2008;359:1700-7.

    From Nayar DS et al. Gastrointest Endosc 2004;60:253-7.

    Reflux symptoms/mucosal breaks not visible in standard video


    endoscopy

    Pemeriksaan Penunjang
    Endoskopi Saluran Cerna Atas: Magnifying
    scope
    Histopatologi
    pH metri 24 jam
    PPI Tes
    Esofagogram
    Manometri esofagus
    Tes Impedans
    Tes Bilitec
    Tes Bernstein
    Surveilance Barretts Esophagus

    Most accurate test for


    measuring pattern, frequency,
    and duration of reflux episodes
    ! Documents correlation between
    reflux episodes and symptoms
    ! Sensitivity (77-100%)
    !

    Normal in 25% of esophagitis!

    Specificity 85-100%
    ! Most useful when diagnosis still
    unclear
    !

    Dent et al. Gut. 1999;44(suppl 2):S1-S16.

    From Smout A. Aliment Pharmacol Ther

    !Considered

    to be the most sensitive test


    for diagnosing reflux
    !Traditional ! transnasal catheter with
    probe situated 5 cm above LES
    !Bravo pH system ! wireless technology

    !PPI

    are standard medical therapy

    Daily PPI generally has a 80% healing rate for

    moderate to severe esophagitis and relief of


    symptoms in up to 90% of patients
    !Overall, all

    PPI are equally effective in


    treating symptoms. However, there is
    some variability in response from patient
    to patient

    !Proper

    timing of PPI administration is


    critical for efficacy

    !30

    minutes before breakfast or other


    large meal

    !In

    select patients, a second dose can be


    added before the evening meal

    !Indications

    Esophagitis
    Stricture
    Barretts metaplasia
    Medication failure
    !Purpose

    of surgery ! restoration the LES

    !In

    development with ongoing studies

    !Most

    try to improve LES function in some


    manner

    !Not

    quite ready for prime time in


    community practice

    ! Decrease

    in symptom

    score
    ! Decreased PPI
    ! No effect on LESP
    ! No effect on acid
    exposure
    ! Some

    serious thermal
    injury complications

    !Decreased

    heartburn symptoms
    !PPI eliminated in 74% of patients at 6
    months
    !Decreased esophageal acid exposure;
    however, only 30% completely
    normalized
    !Long

    term follow-up needed

    TERIMA KASIH

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