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