A- Defining HH:
The hiatal hernia is the protrusion of a portion of the stomach into the thorax through the esophageal hiatus of the diaphragm.
B- Set GERD:
GERD is a physiological in all subjects.
It is considered pathological only when it becomes symptomatic, unusually frequent, prolonged or complicated.
It affects about 10% of the population.
C- Knowing the causes favoring GERD:
The pathophysiology of GERD is multifactorial.
The hiatal hernia is a common but not necessary or sufficient cause.
A GERD can exist without HH.
The most severe forms are associated with the lower pressure collapsed esophageal sphincter.
D- Describe the functional symptoms of GERD:
Heartburn (bottom retro-sternal burning) and regurgitation (lift up to the level of gastric contents pharyngeal) are the essential symptoms of GERD.
Their postural character, postprandial sometimes night is very suggestive.
More rarely coughing or wheezing nocturnal dyspnea, pharyngeal or laryngeal symptoms may be isolated or associated with the previous event.
E- Quote relevant examinations and diagnosis of GERD indication:
These morphological examinations and function studies. Endoscopy especially the diagnosis of reflux esophagitis, which is very characteristic. The review, however, is normal in two of three cases where it is practiced.
Esophageal pH monitoring for 24 hours is the most sensitive functional exploration that characterizes a GERD.
Esophageal manometry is not objective but only GERD predisposing factors of the collapse of the LES pressure or movement disorders of the body of the esophagus.
F- Enter the conduct of diagnosis in the presence of GERD symptoms:
Before age 45, in the presence of typical symptoms, if there is no dysphagia and no weight loss, no further examination is necessary.
If GERD symptoms are atypical, endoscopy allows the diagnosis of GERD lorqu’elle discovers a reflux esophagitis.
In the absence of esophagitis and when symptoms are atypical or resistant to medical treatment a pH monitoring can be useful.
After 45 years, it is recommended to proceed to upper endoscopy in order not to overlook another issue, an associated lesion or endo-brachy-esophagus.
G- Know the evolving risks of GERD:
In the vast majority of cases GERD is a condition not serious and which remains in its evolution.
Severe esophagitis is characterized by extensive superficial ulcerations, confluent or circumferential, or a peptic stricture or a peptic ulcer of the lower esophagus.
Severe reflux esophagitis exposed to the risk of gastrointestinal bleeding.
These complications are sometimes indicative of GERD.
The endo-brachy-esophagus is defined by the presence of a circumferential cylindrical lining type on a greater or lesser height from the cardia.
It has no specific symptoms.
He exhibited at risk of ulcers and especially esophageal adenocarcinoma.
H- Quote the reference method of diagnosis of reflux esophagitis:
This is endoscopy, which when objective erosions and ulcerations, can confirm the diagnosis of reflux esophagitis.
I- Know the principles of medical treatment of symptomatic GERD:
Neutralization of the acid content (antacids), the inhibition of gastric acid secretion (H2 blockers and particularly inhibitors of proton pump), the protection of the oesophageal mucosa (alginates) and the stimulation of oesophageal motility (prokinetic) used alone or in combination, on demand or long-term.
Weight reduction, smoking cessation and alcohol are also useful.
The elevation of the head of the bed is a useful measure for the occurrence of nocturnal reflux.
J- Knowing the principles of treatment of reflux esophagitis depending on its severity:
Peptic esophagitis have to initial treatment antisecretory. Recurrences after discontinuation of antisecretory therapy are even more common than esophagitis was more severe.
These recurrences pose the problem between the alternative medical long-term treatment and surgery. Similarly, the need for medical treatment or long-term deficiencies represented by regurgitation are discussing a surgical indication.
K- Describe the main functional sign of a peptic stricture of the esophagus:
This is dysphagia.
It may be indicative of GERD.
L- List the treatment of peptic esophageal strictures:
In addition to treatment by antisecretory it includes instrumental expansions per-endoscopic and surgical antireflux procedure, desirable whenever it is possible.
M- Principles of GERD surgery:
The surgery aims to achieve antireflux restaurant anatomical conditions that oppose GERD.
In practice, the Nissen fundoplication procedure is the most used technique.