Gastroesophageal Reflux Disease GERD Dr SAPTINO MIRO Sp
![Gastroesophageal Reflux Disease( GERD) Dr. SAPTINO MIRO, Sp. PD BAGIAN ILMU PENYAKIT DALAM FK-UNAND/RS. Gastroesophageal Reflux Disease( GERD) Dr. SAPTINO MIRO, Sp. PD BAGIAN ILMU PENYAKIT DALAM FK-UNAND/RS.](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-1.jpg)
![](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-2.jpg)
![Pendahuluan • GER ( refluks gastroesofageal ) adalah • fenomena yang dapat timbul sewaktu-waktu Pendahuluan • GER ( refluks gastroesofageal ) adalah • fenomena yang dapat timbul sewaktu-waktu](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-3.jpg)
![Epidemiologi • • • Di AS , 33% mengalami GERD Swedia , 12% mengalami Epidemiologi • • • Di AS , 33% mengalami GERD Swedia , 12% mengalami](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-4.jpg)
![Definitions Heartburn: – Burning retrosternal pain radiating upward due to exposure of the oesophagus Definitions Heartburn: – Burning retrosternal pain radiating upward due to exposure of the oesophagus](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-5.jpg)
![Pathophysiology of GERD • The pathophysiology of reflux disease is multifactorial • Gastroduodenal factors Pathophysiology of GERD • The pathophysiology of reflux disease is multifactorial • Gastroduodenal factors](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-6.jpg)
![Pathophysiology of GERD salivary HCO 3 Impaired mucosal defence oesophageal clearance of acid (lying Pathophysiology of GERD salivary HCO 3 Impaired mucosal defence oesophageal clearance of acid (lying](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-7.jpg)
![](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-8.jpg)
![PATOGENESIS GERD(1): ØRefluks isi lambung kedalam esofagus merupakan hal yang normal. ØPatologis bila terjadi PATOGENESIS GERD(1): ØRefluks isi lambung kedalam esofagus merupakan hal yang normal. ØPatologis bila terjadi](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-9.jpg)
![PATOGENESIS GERD(2): ØTerjadi penurunan resistensi jaringan mukosa esophagus ØPola hidup tertentu, pola makan, merokok, PATOGENESIS GERD(2): ØTerjadi penurunan resistensi jaringan mukosa esophagus ØPola hidup tertentu, pola makan, merokok,](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-10.jpg)
![GERD dan motilitas : Ø Kelainan motorik/motilitas esofagus akan berakibat gangguan terhadap bersihan lumen GERD dan motilitas : Ø Kelainan motorik/motilitas esofagus akan berakibat gangguan terhadap bersihan lumen](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-11.jpg)
![GERD & Infeksi H pylori: Ø Peranan infeksi H. pylori dalam patogenesis GERD relatif GERD & Infeksi H pylori: Ø Peranan infeksi H. pylori dalam patogenesis GERD relatif](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-12.jpg)
![Pola hidup & GERD: Ø Peranan alkohol, diet serta faktor psikis tidak signifikan dalam Pola hidup & GERD: Ø Peranan alkohol, diet serta faktor psikis tidak signifikan dalam](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-13.jpg)
![DIAGNOSIS GERD: • Standar baku diagnosis GERD adalah endoskopi saluran cerna bagian atas (SCBA) DIAGNOSIS GERD: • Standar baku diagnosis GERD adalah endoskopi saluran cerna bagian atas (SCBA)](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-14.jpg)
![Diagnosis NERD: Ø Gejala klinik tipikal GERD Ø Tidak ditemukannya mucosal break pada pemeriksaan Diagnosis NERD: Ø Gejala klinik tipikal GERD Ø Tidak ditemukannya mucosal break pada pemeriksaan](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-15.jpg)
![Diagnosis GERD Endoscopi sal. cerna bgn atas kerusakan jaringan. 6 NERD o Tidak ada Diagnosis GERD Endoscopi sal. cerna bgn atas kerusakan jaringan. 6 NERD o Tidak ada](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-16.jpg)
![Pemeriksaan penunjang GERD: Ø Endoskopi Ø Pemeriksaan histopatologi Ø Pemeriksaan p. H metri 24 Pemeriksaan penunjang GERD: Ø Endoskopi Ø Pemeriksaan histopatologi Ø Pemeriksaan p. H metri 24](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-17.jpg)
![Los Angeles classification system for esophagitis Grade A Grade B One or more mucosal Los Angeles classification system for esophagitis Grade A Grade B One or more mucosal](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-18.jpg)
![Savary-Miller classification of esophagitis Grade I One or several erosions in one mucosal fold Savary-Miller classification of esophagitis Grade I One or several erosions in one mucosal fold](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-19.jpg)
![Grade I esophagitis Savary-Miller classification One or several erosions in one mucosal fold Quigley, Grade I esophagitis Savary-Miller classification One or several erosions in one mucosal fold Quigley,](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-20.jpg)
![Grade II esophagitis Savary-Miller classification Several erosions in several mucosal folds, the erosions can Grade II esophagitis Savary-Miller classification Several erosions in several mucosal folds, the erosions can](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-21.jpg)
![Grade III esophagitis Savary-Miller classification Erosions surrounding the oesophageal circumference Freytag et al. , Grade III esophagitis Savary-Miller classification Erosions surrounding the oesophageal circumference Freytag et al. ,](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-22.jpg)
![Grade IV esophagitis Savary-Miller classification Ulcer(s), shortening of the oesophagus Freytag et al. , Grade IV esophagitis Savary-Miller classification Ulcer(s), shortening of the oesophagus Freytag et al. ,](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-23.jpg)
![Grade V esophagitis Savary-Miller classification Moderate Barrett’s oesophagus Freytag et al. , Atlas of Grade V esophagitis Savary-Miller classification Moderate Barrett’s oesophagus Freytag et al. , Atlas of](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-24.jpg)
![Grade IV esophagitis Savary-Miller classification Stricture Nadel, UCHC. Grade IV esophagitis Savary-Miller classification Stricture Nadel, UCHC.](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-25.jpg)
![Grade V esophagitis Savary-Miller classification Moderate Barrett’s oesophagus Freytag et al. , Atlas of Grade V esophagitis Savary-Miller classification Moderate Barrett’s oesophagus Freytag et al. , Atlas of](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-26.jpg)
![Grade V esophagitis Savary-Miller classification Severe Barrett’s oesophagus Freytag et al. , Atlas of Grade V esophagitis Savary-Miller classification Severe Barrett’s oesophagus Freytag et al. , Atlas of](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-27.jpg)
![Adenocarcinoma of the esophagus Nadel/Saint Francis Hospital. In: Gastrointestinal Pathology. Fenoglio-Preiser, New York: Raven Adenocarcinoma of the esophagus Nadel/Saint Francis Hospital. In: Gastrointestinal Pathology. Fenoglio-Preiser, New York: Raven](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-28.jpg)
![Alarm features for GERD Odynophagia Dysphagia Bleeding Alarm features Vomiting Weight loss Nathoo, Int Alarm features for GERD Odynophagia Dysphagia Bleeding Alarm features Vomiting Weight loss Nathoo, Int](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-29.jpg)
![ALGORITME TATA LAKSANA GERD PADA PELAYANAN KESEHATAN LINI PERTAMA GEJALA KHAS GERD Gejala alarm ALGORITME TATA LAKSANA GERD PADA PELAYANAN KESEHATAN LINI PERTAMA GEJALA KHAS GERD Gejala alarm](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-30.jpg)
![Differential diagnosis of GERD Hiatus hernia Esophageal stricture Esophageal cancer Chest pain of cardiac Differential diagnosis of GERD Hiatus hernia Esophageal stricture Esophageal cancer Chest pain of cardiac](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-31.jpg)
![GERD treatment options Lifestyle modifications PPIs Antacids and alginates Approaches H 2 RAs Prokinetic GERD treatment options Lifestyle modifications PPIs Antacids and alginates Approaches H 2 RAs Prokinetic](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-32.jpg)
![Lifestyle modifications for the management of GERD Reduce weight Elevate head of bed Stop Lifestyle modifications for the management of GERD Reduce weight Elevate head of bed Stop](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-33.jpg)
![PRINSIP TERAPI • • PENGENDALIAN p. H asam lambung enzim pepsin bekerja pada p. PRINSIP TERAPI • • PENGENDALIAN p. H asam lambung enzim pepsin bekerja pada p.](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-34.jpg)
![PENGOBATAN GERD: Ø Menghilangkan gejala / keluhan Ø Menyembuhkan lesi esofagus Ø Mencegah kekambuhan PENGOBATAN GERD: Ø Menghilangkan gejala / keluhan Ø Menyembuhkan lesi esofagus Ø Mencegah kekambuhan](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-35.jpg)
![KONSENSUS NASIONAL PENATALAKSANAAN PENYAKIT REFLUKS GASTROESOFAGEAL (GASTROESOPHAGEAL REFLUX DISEASE/GERD) INDONESIA 2004 KONSENSUS NASIONAL PENATALAKSANAAN PENYAKIT REFLUKS GASTROESOFAGEAL (GASTROESOPHAGEAL REFLUX DISEASE/GERD) INDONESIA 2004](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-36.jpg)
![Terapi GERD dengan PPI: Ø Pengobatan awal dengan PPI dengan dosis ganda selama 8 Terapi GERD dengan PPI: Ø Pengobatan awal dengan PPI dengan dosis ganda selama 8](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-37.jpg)
![Penatalaksanaan GERD TERDUGA KASUS REFLUKS UNINVESTIGATED Keluhan berulang PENGOBATAN EMPIRIK 2 minggu ( PPI Penatalaksanaan GERD TERDUGA KASUS REFLUKS UNINVESTIGATED Keluhan berulang PENGOBATAN EMPIRIK 2 minggu ( PPI](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-38.jpg)
![ALGORITME TATA LAKSANA GERD PADA PELAYANAN KESEHATAN LINI PERTAMA Gejala khas GERD • Heartburn ALGORITME TATA LAKSANA GERD PADA PELAYANAN KESEHATAN LINI PERTAMA Gejala khas GERD • Heartburn](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-39.jpg)
![Algorithm Pengobatan Yang dianjurkan untuk Pasien GERD Uninvestigated, Mild EE Atau NERD PPI On-Demand Algorithm Pengobatan Yang dianjurkan untuk Pasien GERD Uninvestigated, Mild EE Atau NERD PPI On-Demand](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-40.jpg)
![Pertimbangan terapi GERD PPI : Cepat dalam menghilangkan keseluruhan gejala Cepat dalam penyembuhan Pendekatan Pertimbangan terapi GERD PPI : Cepat dalam menghilangkan keseluruhan gejala Cepat dalam penyembuhan Pendekatan](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-41.jpg)
![KESIMPULAN • Terdapat peningkatan prevalensi GERD • Patofisiolgi multifaktor akibat peningkat an asam lambung, KESIMPULAN • Terdapat peningkatan prevalensi GERD • Patofisiolgi multifaktor akibat peningkat an asam lambung,](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-42.jpg)
![MINAL AIDIN WAL FAIDZIN MAAF LAHIR DAN BATHIN TERIMA KASIH MINAL AIDIN WAL FAIDZIN MAAF LAHIR DAN BATHIN TERIMA KASIH](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-43.jpg)
- Slides: 43
![Gastroesophageal Reflux Disease GERD Dr SAPTINO MIRO Sp PD BAGIAN ILMU PENYAKIT DALAM FKUNANDRS Gastroesophageal Reflux Disease( GERD) Dr. SAPTINO MIRO, Sp. PD BAGIAN ILMU PENYAKIT DALAM FK-UNAND/RS.](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-1.jpg)
Gastroesophageal Reflux Disease( GERD) Dr. SAPTINO MIRO, Sp. PD BAGIAN ILMU PENYAKIT DALAM FK-UNAND/RS. M. DJAMIL PADANG
![](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-2.jpg)
![Pendahuluan GER refluks gastroesofageal adalah fenomena yang dapat timbul sewaktuwaktu Pendahuluan • GER ( refluks gastroesofageal ) adalah • fenomena yang dapat timbul sewaktu-waktu](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-3.jpg)
Pendahuluan • GER ( refluks gastroesofageal ) adalah • fenomena yang dapat timbul sewaktu-waktu pada populasi umum , terutama sehabis makan dan kemudian kembali seperti normal refluks fisiologis. Dikatakan patologis (GERD) bila terjadi refluks berulang dalam waktu lama sehingga menim bulkan keluhan/kerusakan mukosa esofagus • Terdapat peningkatan prevalensi GERD
![Epidemiologi Di AS 33 mengalami GERD Swedia 12 mengalami Epidemiologi • • • Di AS , 33% mengalami GERD Swedia , 12% mengalami](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-4.jpg)
Epidemiologi • • • Di AS , 33% mengalami GERD Swedia , 12% mengalami heartburn Singapura ( 1998) 1. 6 % , Taiwan 6% Indonesia ( ? ), M. Djamil GERD 66. 4%, BRG 24. 5%
![Definitions Heartburn Burning retrosternal pain radiating upward due to exposure of the oesophagus Definitions Heartburn: – Burning retrosternal pain radiating upward due to exposure of the oesophagus](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-5.jpg)
Definitions Heartburn: – Burning retrosternal pain radiating upward due to exposure of the oesophagus to acid Esophagitis : – Endoscopically demonstrated damage to the oesophageal mucosa Gastro-esophageal reflux disease (GERD): – Pathological reflux ranges from simple to erosive to Barrett’s Non-erosive reflux disease (NERD): – Reflux disease in which erosion does not occur Talley et al. , BMJ 2001; 323: 1294– 7. de Caestecker, BMJ 2001; 323: 736– 9. Nathoo, Int J Clin Pract 2001; 55: 465– 9. Quigley, Eur J Gastroenterol Hepatol 2001; 13(Suppl 1): S 13– 18.
![Pathophysiology of GERD The pathophysiology of reflux disease is multifactorial Gastroduodenal factors Pathophysiology of GERD • The pathophysiology of reflux disease is multifactorial • Gastroduodenal factors](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-6.jpg)
Pathophysiology of GERD • The pathophysiology of reflux disease is multifactorial • Gastroduodenal factors : • • • - Acid and pepsin - Duodenal agents - Gastric emptying - Helicobacter pylori ? Gastroesophageal junction factors : - Transient lower esophageal sphincter relaxation - Hypotensive lower esophageal sphincters - Hiatal hernia Esophageal factors : - Esophageal clearance Genetic factors Fass R. GERD. 2004
![Pathophysiology of GERD salivary HCO 3 Impaired mucosal defence oesophageal clearance of acid lying Pathophysiology of GERD salivary HCO 3 Impaired mucosal defence oesophageal clearance of acid (lying](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-7.jpg)
Pathophysiology of GERD salivary HCO 3 Impaired mucosal defence oesophageal clearance of acid (lying flat, alcohol, coffee) Impaired LOS (smoking, fat, alcohol) – – Hiatus hernia transient LOS relaxations basal tone bile reflux H+ Bile and pancreatic enzymes Pepsin acid output (smoking, coffee) intragastric pressure (obesity, lying flat) gastric emptying (fat) de Caestecker, BMJ 2001; 323: 736– 9. Johanson, Am J Med 2000; 108(Suppl 4 A): S 99– 103.
![](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-8.jpg)
![PATOGENESIS GERD1 ØRefluks isi lambung kedalam esofagus merupakan hal yang normal ØPatologis bila terjadi PATOGENESIS GERD(1): ØRefluks isi lambung kedalam esofagus merupakan hal yang normal. ØPatologis bila terjadi](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-9.jpg)
PATOGENESIS GERD(1): ØRefluks isi lambung kedalam esofagus merupakan hal yang normal. ØPatologis bila terjadi gangguan bersihan lumen esofagus terhadap isi lambung ØProses berlangsung lama dan berulang
![PATOGENESIS GERD2 ØTerjadi penurunan resistensi jaringan mukosa esophagus ØPola hidup tertentu pola makan merokok PATOGENESIS GERD(2): ØTerjadi penurunan resistensi jaringan mukosa esophagus ØPola hidup tertentu, pola makan, merokok,](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-10.jpg)
PATOGENESIS GERD(2): ØTerjadi penurunan resistensi jaringan mukosa esophagus ØPola hidup tertentu, pola makan, merokok, berat badan ØInfeksi H pylori? ØPenurunan tonus sfingter esofagus bawah ?
![GERD dan motilitas Ø Kelainan motorikmotilitas esofagus akan berakibat gangguan terhadap bersihan lumen GERD dan motilitas : Ø Kelainan motorik/motilitas esofagus akan berakibat gangguan terhadap bersihan lumen](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-11.jpg)
GERD dan motilitas : Ø Kelainan motorik/motilitas esofagus akan berakibat gangguan terhadap bersihan lumen dari refluksat. Ø Lamanya kontak refluksat dengan mukosa esofagus disertai dengan frekuensi refluks akan dapat berakibat terjadinya GERD Ø Tonus LES juga dapat berakibat lebih beratnya kelainan
![GERD Infeksi H pylori Ø Peranan infeksi H pylori dalam patogenesis GERD relatif GERD & Infeksi H pylori: Ø Peranan infeksi H. pylori dalam patogenesis GERD relatif](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-12.jpg)
GERD & Infeksi H pylori: Ø Peranan infeksi H. pylori dalam patogenesis GERD relatif kecil dan kurang didukung oleh data yang ada. Ø Ada hubungan terbalik antara infeksi H. pylori dengan strain yang virulens (Cag A Positif) dengan kejadian esofagitis, Barrett’s esophagus & adenokarsinoma esofagus
![Pola hidup GERD Ø Peranan alkohol diet serta faktor psikis tidak signifikan dalam Pola hidup & GERD: Ø Peranan alkohol, diet serta faktor psikis tidak signifikan dalam](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-13.jpg)
Pola hidup & GERD: Ø Peranan alkohol, diet serta faktor psikis tidak signifikan dalam patogenesis GERD. Ø Beberapa studi observasional telah menunjukkan pengaruh merokok dan berat badan lebih sebagai faktor risiko terjadinya GERD
![DIAGNOSIS GERD Standar baku diagnosis GERD adalah endoskopi saluran cerna bagian atas SCBA DIAGNOSIS GERD: • Standar baku diagnosis GERD adalah endoskopi saluran cerna bagian atas (SCBA)](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-14.jpg)
DIAGNOSIS GERD: • Standar baku diagnosis GERD adalah endoskopi saluran cerna bagian atas (SCBA) dengan ditemukannya mucosal break di esophagus • Anamnesis yang cermat merupakan alat utama untuk menegakkan diagnosis GERD
![Diagnosis NERD Ø Gejala klinik tipikal GERD Ø Tidak ditemukannya mucosal break pada pemeriksaan Diagnosis NERD: Ø Gejala klinik tipikal GERD Ø Tidak ditemukannya mucosal break pada pemeriksaan](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-15.jpg)
Diagnosis NERD: Ø Gejala klinik tipikal GERD Ø Tidak ditemukannya mucosal break pada pemeriksaan endoskopi SCBA Ø Pemeriksaan p. H esofagus dengan hasil positif Ø Terapi empiris yang banyak dikenal dengan Proton Pump Inhibitor (PPI) Test dengan hasil positif.
![Diagnosis GERD Endoscopi sal cerna bgn atas kerusakan jaringan 6 NERD o Tidak ada Diagnosis GERD Endoscopi sal. cerna bgn atas kerusakan jaringan. 6 NERD o Tidak ada](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-16.jpg)
Diagnosis GERD Endoscopi sal. cerna bgn atas kerusakan jaringan. 6 NERD o Tidak ada kerusakan jaringan (endoskopi) o Pemeriksaan p. H esophagus hasil (+) o Terapi empiris (PPI test) hasil (+) Anamnesis. 7 dan pemeriksan penunjang lainnya
![Pemeriksaan penunjang GERD Ø Endoskopi Ø Pemeriksaan histopatologi Ø Pemeriksaan p H metri 24 Pemeriksaan penunjang GERD: Ø Endoskopi Ø Pemeriksaan histopatologi Ø Pemeriksaan p. H metri 24](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-17.jpg)
Pemeriksaan penunjang GERD: Ø Endoskopi Ø Pemeriksaan histopatologi Ø Pemeriksaan p. H metri 24 jam Ø Penunjang diagnostik lain: Esofagografi dengan barium, Manometri esofagus
![Los Angeles classification system for esophagitis Grade A Grade B One or more mucosal Los Angeles classification system for esophagitis Grade A Grade B One or more mucosal](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-18.jpg)
Los Angeles classification system for esophagitis Grade A Grade B One or more mucosal breaks, no longer than 5 mm, that do not extend between the tops of two mucosal folds One or more mucosal breaks, more than 5 mm long, that do not extend between the tops of two mucosal folds Grade C Grade D One or more mucosal breaks, that are continuous between the tops of two or more mucosal folds, but which involve less than 75% of the circumference One or more mucosal breaks, that involve at least 75% of the oesophageal circumference Lundell et al. , Gut 1999; 45: 172– 80.
![SavaryMiller classification of esophagitis Grade I One or several erosions in one mucosal fold Savary-Miller classification of esophagitis Grade I One or several erosions in one mucosal fold](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-19.jpg)
Savary-Miller classification of esophagitis Grade I One or several erosions in one mucosal fold Grade II Several erosions in several mucosal folds, the erosions can merge Grade III Erosions surrounding the oesophageal circumference Grade IV Ulcer(s), strictures, shortening of the oesophagus Grade V Barrett’s epithelium Savary & Miller. The Esophagus. In: Handbook & Atlas of Endoscopy. Solothurn, Switzerland: Verlag Gassman AG, 1978: 119– 205.
![Grade I esophagitis SavaryMiller classification One or several erosions in one mucosal fold Quigley Grade I esophagitis Savary-Miller classification One or several erosions in one mucosal fold Quigley,](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-20.jpg)
Grade I esophagitis Savary-Miller classification One or several erosions in one mucosal fold Quigley, Eur J Gastroenterol Hepatol 2001; 13(Suppl 1): S 13– 18. Nathoo, Int J Clin Pract 2001; 55: 465– 9. www. gastrolab. net
![Grade II esophagitis SavaryMiller classification Several erosions in several mucosal folds the erosions can Grade II esophagitis Savary-Miller classification Several erosions in several mucosal folds, the erosions can](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-21.jpg)
Grade II esophagitis Savary-Miller classification Several erosions in several mucosal folds, the erosions can merge www. gastrolab. net
![Grade III esophagitis SavaryMiller classification Erosions surrounding the oesophageal circumference Freytag et al Grade III esophagitis Savary-Miller classification Erosions surrounding the oesophageal circumference Freytag et al. ,](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-22.jpg)
Grade III esophagitis Savary-Miller classification Erosions surrounding the oesophageal circumference Freytag et al. , Atlas of gastrointestinal endoscopy. www. home. t-online. de/home/afreytag/indexe. htm
![Grade IV esophagitis SavaryMiller classification Ulcers shortening of the oesophagus Freytag et al Grade IV esophagitis Savary-Miller classification Ulcer(s), shortening of the oesophagus Freytag et al. ,](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-23.jpg)
Grade IV esophagitis Savary-Miller classification Ulcer(s), shortening of the oesophagus Freytag et al. , Atlas of gastrointestinal endoscopy. www. home. t-online. de/home/afreytag/indexe. htm
![Grade V esophagitis SavaryMiller classification Moderate Barretts oesophagus Freytag et al Atlas of Grade V esophagitis Savary-Miller classification Moderate Barrett’s oesophagus Freytag et al. , Atlas of](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-24.jpg)
Grade V esophagitis Savary-Miller classification Moderate Barrett’s oesophagus Freytag et al. , Atlas of gastrointestinal endoscopy. www. home. t-online. de/home/afreytag/indexe. htm
![Grade IV esophagitis SavaryMiller classification Stricture Nadel UCHC Grade IV esophagitis Savary-Miller classification Stricture Nadel, UCHC.](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-25.jpg)
Grade IV esophagitis Savary-Miller classification Stricture Nadel, UCHC.
![Grade V esophagitis SavaryMiller classification Moderate Barretts oesophagus Freytag et al Atlas of Grade V esophagitis Savary-Miller classification Moderate Barrett’s oesophagus Freytag et al. , Atlas of](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-26.jpg)
Grade V esophagitis Savary-Miller classification Moderate Barrett’s oesophagus Freytag et al. , Atlas of gastrointestinal endoscopy. www. home. t-online. de/home/afreytag/indexe. htm
![Grade V esophagitis SavaryMiller classification Severe Barretts oesophagus Freytag et al Atlas of Grade V esophagitis Savary-Miller classification Severe Barrett’s oesophagus Freytag et al. , Atlas of](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-27.jpg)
Grade V esophagitis Savary-Miller classification Severe Barrett’s oesophagus Freytag et al. , Atlas of gastrointestinal endoscopy. www. home. t-online. de/home/afreytag/indexe. htm
![Adenocarcinoma of the esophagus NadelSaint Francis Hospital In Gastrointestinal Pathology FenoglioPreiser New York Raven Adenocarcinoma of the esophagus Nadel/Saint Francis Hospital. In: Gastrointestinal Pathology. Fenoglio-Preiser, New York: Raven](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-28.jpg)
Adenocarcinoma of the esophagus Nadel/Saint Francis Hospital. In: Gastrointestinal Pathology. Fenoglio-Preiser, New York: Raven Press, 1989: 96– 100.
![Alarm features for GERD Odynophagia Dysphagia Bleeding Alarm features Vomiting Weight loss Nathoo Int Alarm features for GERD Odynophagia Dysphagia Bleeding Alarm features Vomiting Weight loss Nathoo, Int](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-29.jpg)
Alarm features for GERD Odynophagia Dysphagia Bleeding Alarm features Vomiting Weight loss Nathoo, Int J Clin Pract 2001; 55: 465– 9.
![ALGORITME TATA LAKSANA GERD PADA PELAYANAN KESEHATAN LINI PERTAMA GEJALA KHAS GERD Gejala alarm ALGORITME TATA LAKSANA GERD PADA PELAYANAN KESEHATAN LINI PERTAMA GEJALA KHAS GERD Gejala alarm](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-30.jpg)
ALGORITME TATA LAKSANA GERD PADA PELAYANAN KESEHATAN LINI PERTAMA GEJALA KHAS GERD Gejala alarm Umur > 40 th Tanpa gejala alarm Terapi empirik Tes PPI Respon menetap Respon baik Endoskopi Terapi min-4 minggu kambuh Konsensus Gerd , 2004 On demand therapy
![Differential diagnosis of GERD Hiatus hernia Esophageal stricture Esophageal cancer Chest pain of cardiac Differential diagnosis of GERD Hiatus hernia Esophageal stricture Esophageal cancer Chest pain of cardiac](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-31.jpg)
Differential diagnosis of GERD Hiatus hernia Esophageal stricture Esophageal cancer Chest pain of cardiac origin Functional dyspepsia Nathoo, Int J Clin Pract 2001; 55: 465– 9.
![GERD treatment options Lifestyle modifications PPIs Antacids and alginates Approaches H 2 RAs Prokinetic GERD treatment options Lifestyle modifications PPIs Antacids and alginates Approaches H 2 RAs Prokinetic](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-32.jpg)
GERD treatment options Lifestyle modifications PPIs Antacids and alginates Approaches H 2 RAs Prokinetic motility agents Hatlebakk & Berstad, Clin Pharmacokinet 1996; 31: 386– 406.
![Lifestyle modifications for the management of GERD Reduce weight Elevate head of bed Stop Lifestyle modifications for the management of GERD Reduce weight Elevate head of bed Stop](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-33.jpg)
Lifestyle modifications for the management of GERD Reduce weight Elevate head of bed Stop smoking Modifications Avoid reflux-promoting agents (e. g. alcohol, coffee, some foods) (not evidence based) Eat small meals, no late meals, reduce fat
![PRINSIP TERAPI PENGENDALIAN p H asam lambung enzim pepsin bekerja pada p PRINSIP TERAPI • • PENGENDALIAN p. H asam lambung enzim pepsin bekerja pada p.](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-34.jpg)
PRINSIP TERAPI • • PENGENDALIAN p. H asam lambung enzim pepsin bekerja pada p. H ideal = 2 -2. 5 pada p. H > 4 aktivitas pepsin menurun drastis Enzim pepsin bekerja mencerna dinding protein lambung
![PENGOBATAN GERD Ø Menghilangkan gejala keluhan Ø Menyembuhkan lesi esofagus Ø Mencegah kekambuhan PENGOBATAN GERD: Ø Menghilangkan gejala / keluhan Ø Menyembuhkan lesi esofagus Ø Mencegah kekambuhan](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-35.jpg)
PENGOBATAN GERD: Ø Menghilangkan gejala / keluhan Ø Menyembuhkan lesi esofagus Ø Mencegah kekambuhan Ø Memperbaiki kualitas hidup Ø Mencegah timbulnya komplikasi
![KONSENSUS NASIONAL PENATALAKSANAAN PENYAKIT REFLUKS GASTROESOFAGEAL GASTROESOPHAGEAL REFLUX DISEASEGERD INDONESIA 2004 KONSENSUS NASIONAL PENATALAKSANAAN PENYAKIT REFLUKS GASTROESOFAGEAL (GASTROESOPHAGEAL REFLUX DISEASE/GERD) INDONESIA 2004](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-36.jpg)
KONSENSUS NASIONAL PENATALAKSANAAN PENYAKIT REFLUKS GASTROESOFAGEAL (GASTROESOPHAGEAL REFLUX DISEASE/GERD) INDONESIA 2004
![Terapi GERD dengan PPI Ø Pengobatan awal dengan PPI dengan dosis ganda selama 8 Terapi GERD dengan PPI: Ø Pengobatan awal dengan PPI dengan dosis ganda selama 8](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-37.jpg)
Terapi GERD dengan PPI: Ø Pengobatan awal dengan PPI dengan dosis ganda selama 8 minggu dengan dosis ganda. Ø Selanjutnya tergantung perbaikan klinik dan endoskopi, dalam bentuk terapi on demand atau maintenance therapy sampai 6 bulan Ø PPI dosis ganda selama 8 minggu dapat memberikan healing rate lebih dari 80%
![Penatalaksanaan GERD TERDUGA KASUS REFLUKS UNINVESTIGATED Keluhan berulang PENGOBATAN EMPIRIK 2 minggu PPI Penatalaksanaan GERD TERDUGA KASUS REFLUKS UNINVESTIGATED Keluhan berulang PENGOBATAN EMPIRIK 2 minggu ( PPI](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-38.jpg)
Penatalaksanaan GERD TERDUGA KASUS REFLUKS UNINVESTIGATED Keluhan berulang PENGOBATAN EMPIRIK 2 minggu ( PPI test ? ) PPI test : 1 -2 minggu Dosis ganda (Sensitivitas 6880%) Esofagitis ringan NERD TERAPI “BILA PERLU” Indonesia GERD study group Gejala Alarm/ Usia > 40 tahun INVESTIGATED TERAPI AWAL / INITIAL Esofagitis sedang & berat Gejala berulang TERAPI PEMELIHARAAN
![ALGORITME TATA LAKSANA GERD PADA PELAYANAN KESEHATAN LINI PERTAMA Gejala khas GERD Heartburn ALGORITME TATA LAKSANA GERD PADA PELAYANAN KESEHATAN LINI PERTAMA Gejala khas GERD • Heartburn](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-39.jpg)
ALGORITME TATA LAKSANA GERD PADA PELAYANAN KESEHATAN LINI PERTAMA Gejala khas GERD • Heartburn • Regurgitasi Gejala Alarm/ Umur > 40 tahun Tanpa gejala Alarm Respon menetap Endoskopi GERD+ kekambuhan Indonesia GERD study group Respon baik Terapi minimal 4 minggu On demand therapy
![Algorithm Pengobatan Yang dianjurkan untuk Pasien GERD Uninvestigated Mild EE Atau NERD PPI OnDemand Algorithm Pengobatan Yang dianjurkan untuk Pasien GERD Uninvestigated, Mild EE Atau NERD PPI On-Demand](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-40.jpg)
Algorithm Pengobatan Yang dianjurkan untuk Pasien GERD Uninvestigated, Mild EE Atau NERD PPI On-Demand Indonesia GERD study group PPI Pengobatan awal 4 -8 minggu Severe EE , Serangan Yang sering Atau Respons PPI lambat PPI Maintenance
![Pertimbangan terapi GERD PPI Cepat dalam menghilangkan keseluruhan gejala Cepat dalam penyembuhan Pendekatan Pertimbangan terapi GERD PPI : Cepat dalam menghilangkan keseluruhan gejala Cepat dalam penyembuhan Pendekatan](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-41.jpg)
Pertimbangan terapi GERD PPI : Cepat dalam menghilangkan keseluruhan gejala Cepat dalam penyembuhan Pendekatan Step-down Yang dipilih : Cepat dalam penghambatan asam Konsisten mengontrol asam pada p. H>4 Sedikit interaksi dengan obat lain Sedikit efek pada cytochrome P 450 Omeprazole ? Lanzoprazole ? Pantoprazole ? Rabeprazole ? Esomeprazole ?
![KESIMPULAN Terdapat peningkatan prevalensi GERD Patofisiolgi multifaktor akibat peningkat an asam lambung KESIMPULAN • Terdapat peningkatan prevalensi GERD • Patofisiolgi multifaktor akibat peningkat an asam lambung,](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-42.jpg)
KESIMPULAN • Terdapat peningkatan prevalensi GERD • Patofisiolgi multifaktor akibat peningkat an asam lambung, gangguan motilitas, dll • Keluhan berupa heartburn , noncardiac chest-pain • Terapi life style
![MINAL AIDIN WAL FAIDZIN MAAF LAHIR DAN BATHIN TERIMA KASIH MINAL AIDIN WAL FAIDZIN MAAF LAHIR DAN BATHIN TERIMA KASIH](https://slidetodoc.com/presentation_image_h/adcf03925db7388995b374b1b57f1dea/image-43.jpg)
MINAL AIDIN WAL FAIDZIN MAAF LAHIR DAN BATHIN TERIMA KASIH
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