Tuesday, 26 November 2013

Gastro-esophageal reflux disease (GERD)- Diagnosis and tests

The prevalence of upper gastrointestinal (GI) diseases is increasing in subjects aged 65 years and over. Pathophysiological changes in esophageal functions that occur with aging may, at least in part, be responsible for the high prevalence of
1. Gastro-esophageal reflux disease (GERD) in old age.
2. The incidence of gastric and duodenal ulcers and their bleeding complications is increasing in old-aged populations worldwide.
3.  H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis
4.  Almost 40% of GU and 25% of DU in the elderly patients are associated with the use of NSAID(1) and/or aspirin(2).(a)
I.  Gastro-esophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD), also known as gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease, is defined as a chronic condition of liquid stomach acid refluxing back up from the stomach into the esophagus, causing heartburn. According to the study of “Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.” by DeVault KR, Castell DO; American College of Gastroenterology, GERD is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.
Diagnosis and tests
If you are experience some of the above symptoms, after recording your family history and physical exam, the following test may be recommended by your doctor
1. Esophagogastroduodenoscopy (EGD)
Esophagogastroduodenoscopy (EGD) also known as upper gastrointestinal endoscopy is a diagnosis procedure allowing your doctor to check for any abnormality in the lining of the esophagus, stomach, and upper duodenum after a flexible endoscope inserted down the throat.
If any abnormality is found, your doctor order further examinations.
2. Barium swallow
Barium swallow is a medical imaging procedure which allows your doctor to examine the upper GI (gastrointestinal) tract, to exam the lining of the esophagus and the stomach, after you have drunk a suspension of barium sulfate.
3. Chest X-rays
A chest x-ray is an x-ray of the chest that allows your doctor to examine the lining of the esophagus, stomach, and upper duodenum.
4. Biopsy
A biopsy is a test of removal sample of cells or tissues for examination and determination of the grade and type of the tumors by examining them under a microscope by a pathologist or chemically, if the location of the tumor allows the test to be done without major risk to the patient.
4. Esophageal manometry
Esophageal manometry is a test with the use of a pressure-sensitive tube-like thin instrument passed through your mouth or nose and into your stomach to allow your doctor to examine the motor function of the Upper Esophageal Sphincter (UES), Esophageal body and Lower Esophageal Sphincter (LES).
5. Etc.
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(a) http://www.ncbi.nlm.nih.gov/pubmed/15588798
(1) http://www.ncbi.nlm.nih.gov/pubmed/16001646
(2) http://www.ncbi.nlm.nih.gov/pubmed/22542157

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