persentase mama okky
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Gastroesophageal Gastroesophageal RReflux eflux DDisease( GERD) isease( GERD)
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PendahuluanPendahuluan
• GER ( refluks gastroesofageal ) adalah GER ( refluks gastroesofageal ) adalah
fenomena yang dapat timbul sewaktu-waktu fenomena yang dapat timbul sewaktu-waktu
pada populasi umum , terutama sehabis pada populasi umum , terutama sehabis
makan dan kemudian kembali seperti normal makan dan kemudian kembali seperti normal
refluks fisiologis.refluks fisiologis.• Dikatakan patologis (GERD) bila terjadi refluks Dikatakan patologis (GERD) bila terjadi refluks
berulang dalam waktu lama sehingga menimberulang dalam waktu lama sehingga menim
bulkan keluhan/kerusakan mukosa esofagusbulkan keluhan/kerusakan mukosa esofagus
• Terdapat peningkatan prevalensi GERDTerdapat peningkatan prevalensi GERD
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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): S13–18.
Heartburn: – Burning retrosternal pain radiating upward due
to exposure of the oesophagus to acid
Esophagitis :– Endoscopically demonstrated damage to
the oesophageal mucosaGastro-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
DefinitionsDefinitions
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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
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Quigley, Eur J Gastroenterol Hepatol 2001; 13(Suppl 1): S13–18.Nathoo, Int J Clin Pract 2001; 55: 465–9.
www.gastrolab.net
Savary-Miller classification
One or several erosions in one mucosal fold
Grade I esophagitisGrade I esophagitis
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www.gastrolab.net
Savary-Miller classification
Several erosions in several mucosal folds, the erosions can merge
Grade II esophagitisGrade II esophagitis
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Freytag et al., Atlas of gastrointestinal endoscopy. www.home.t-online.de/home/afreytag/indexe.htm
Savary-Miller classification
Erosions surrounding the oesophageal circumference
Grade III esophagitisGrade III esophagitis
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Freytag et al., Atlas of gastrointestinal endoscopy. www.home.t-online.de/home/afreytag/indexe.htm
Savary-Miller classification
Ulcer(s), shortening of the oesophagus
Grade IV esophagitisGrade IV esophagitis
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Freytag et al., Atlas of gastrointestinal endoscopy. www.home.t-online.de/home/afreytag/indexe.htm
Savary-Miller classification
Moderate Barrett’s oesophagus
Grade V esophagitisGrade V esophagitis
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Nadel, UCHC.
Savary-Miller classification
Stricture
Grade IV esophagitisGrade IV esophagitis
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Freytag et al., Atlas of gastrointestinal endoscopy. www.home.t-online.de/home/afreytag/indexe.htm
Savary-Miller classification
Moderate Barrett’s oesophagus
Grade V esophagitisGrade V esophagitis
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Freytag et al., Atlas of gastrointestinal endoscopy. www.home.t-online.de/home/afreytag/indexe.htm
Savary-Miller classification
Severe Barrett’s oesophagus
Grade V esophagitisGrade V esophagitis
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Nadel/Saint Francis Hospital. In: Gastrointestinal Pathology. Fenoglio-Preiser, New York: Raven Press, 1989: 96–100.
Adenocarcinoma of the esophagus
Adenocarcinoma of the esophagus
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Odynophagia
Dysphagia
Vomiting
Bleeding
Weight loss
Alarm features
Nathoo, Int J Clin Pract 2001; 55: 465–9.
Alarm features for GERDAlarm features for GERD
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ALGORITME TATA LAKSANA GERD PADA PELAYANAN KESEHATAN LINI PERTAMA
GEJALA KHAS GERD
Gejala alarmUmur > 40 th Tanpa gejala alarm
Terapi empirikTes PPI
Respon menetap Respon baik
Terapi min-4 minggu
On demand therapy
kambuh
Endoskopi
Konsensus Gerd ,2004
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PENGOBATAN GERD:
Menghilangkan gejala / keluhanMenyembuhkan lesi esofagusMencegah kekambuhanMemperbaiki kualitas hidupMencegah timbulnya komplikasi
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Terapi GERD dengan PPI:
Pengobatan awal dengan PPI dengan dosis ganda selama 8 minggu dengan dosis ganda.
Selanjutnya tergantung perbaikan klinik dan endoskopi, dalam bentuk terapi on demand atau maintenance therapy sampai 6 bulan
PPI dosis ganda selama 8 minggu dapat memberikan healing rate lebih dari 80%
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PPI Pengobatan awal
4-8 minggu
Algorithm Pengobatan Yang dianjurkan untuk Pasien GERD
PPIOn-Demand
PPIMaintenance
Severe EE , Serangan Yang sering
Atau Respons PPI lambat
Uninvestigated,
Mild EE
Atau NERD
Indonesia GERD study group
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PPI : Cepat dalam menghilangkan keseluruhan gejala
Cepat dalam penyembuhan
Pendekatan Step-down
Yang dipilih :
Cepat dalam penghambatan asam
Konsisten mengontrol asam pada pH>4
Sedikit interaksi dengan obat lain
Sedikit efek pada cytochrome P450
Omeprazole ? Rabeprazole ?Lanzoprazole ? Esomeprazole ? Pantoprazole ?
Pertimbangan terapi GERD
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KESIMPULANKESIMPULAN
• Terdapat peningkatan prevalensi GERDTerdapat peningkatan prevalensi GERD• Patofisiolgi multifaktor akibat peningkat Patofisiolgi multifaktor akibat peningkat an asam lambung, gangguan motilitas,dllan asam lambung, gangguan motilitas,dll• Keluhan berupa heartburn , noncardiac Keluhan berupa heartburn , noncardiac
chest-painchest-pain• Terapi life styleTerapi life style
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Thank you Thank you andand
TERIMA KASIHTERIMA KASIH