GASTROESOPHAGEAL REFLUX DISEASE – A MULTIFACETED DISEASE

Refl uks želučanog sadržaja u jednjak fi ziološki je fenomen koji se povremeno događaja kod ljudi i to najčešće nakon obroka. Gastroezofagelna refl uksna bolest (GERB) je stanje koje nastaje kada količina želučanog sadržaja nadmašuje njegovu fiziološku eliminaciju iz jednjaka i uzrokuje tegobe s pridruženim oštećenjem sluznice jednaka ili bez tog oštećenja te uzrokuje zabrinjavajuće simptome. Simptomi se smatraju zabrinjavajućima ako remete bolesnikovo opće stanje i razlog su posjete liječniku. Prevalencija GERB-a u zapadnom svijetu iznosi 10-20 %, a temelji se na procjeni pojavnosti žgaravice kao vodećeg simptoma. Dominantni simptomi su žgaravica i regurgitacija osobito nakon konzumacije obilnog i masnog obroka i visoko su specifi čni za GERB. Ekstraezofagealna refl uksna bolest (EERB) je široki spektar pojavnosti različitih simptoma povezanih s gornjim i donjim dijelom respiratornog sistema kao što su kašalj, laringitis, astma, kronična opstruktivna bolest pluća (KOPB), promuklost, sinusitis - postnazalni drip (kapajući) sindrom, upala srednjeg uha, rekurentna pneumonija i karcinom larinksa. U diferencijalnoj dijagnostici refl uksa koriste se sljedeći testovi: ezofagogastroduodenoskopija, laringoskopija i 24-satni pH monitoring. Inicijalna empirijska terapija inhibitorom protonske pumpe provodi se dva put/dan u trajanju od 1 do 2 mjeseca.Gastric content refl ux to the esophagus is a physiological phenomenon that occasionally occurs after meal. Gastroesophageal refl ux disease (GERD) is a state that appears when the quantity of gastric content surpasses its physiological elimination from the esophagus and causes diffi culties with or without associated esophageal mucosa damage, as well as alarming symptoms. The symptoms are defi ned as alarming if they disturb the patient’s well-being and are the reason for a visit to the physician. The prevalence of GERD in the Western world is 10%-20% and is based on the estimation of the heartburn incidence as the leading symptom. The dominant symptoms are heartburn and regurgitation, especially after a heavy meal, and are highly specifi c for GERD. Extraesophageal refl ux disease represents a wide range of symptoms connected to the upper and lower respiratory system, such as cough, laryngitis, asthma, chronic obstructive pulmonary disease, hoarseness, sinusitis-postnasal drip syndrome, otitis media, recurrent pneumonia and laryngeal carcinoma. The following tests are used in the refl ux differential diagnosis: esophagogastroscopy, laryngoscopy and 24-hour pH monitoring. Patients suspected to suffer from GERD are initially treated with empirical proton pump inhibitor therapy twice a day for one to two months