1. [3]

2. / , , , functional chest pain, functional dysphagia. Esophageal disorder: Gastroduodenal disorders : functional dyspepsia, aerophagia, functional vomitting

3.

4. Spectrum of GERD Heartburn (Nonerosive Reflux Disease :NERD)

5. Spectrum of esophagitis

6. 0% , , , , , , , , ,

7. , (, )

8. : 1. (transient LES relaxation: tLESR) 2. 3. 4. 5.

9. citrus ? Anticholinergics Benzodiazepines (diazepam narcotics) -adrenergic agonists calcium channel blockers Opioids Progesterone Xanthines Aspirin & NSAID Quinidine tetracyclin

10. ( Savary -Miller ) Grade 1. Grade 4. , Grade 2. .( ) Grade 3. Grade 5.

11. LA Group A : mucosal break 5mm Group B : 1 mucosal break 5mm Group C : mucosal break (75%) Group D : (circumferential) mucosal break(75%) (z-line blurring), (indistinct erythema / hyperemia), (white turbid dislocation), (loss of vascularity) (minimal change) .

12. Group A : mucosal break 5mm

13. Group B : 1 mucosal break 5mm

14. Group C : mucosal break (75%)

15. Group D : (circumferential) mucosal break(75%)

16. 1. 2. alginic acid 3. 4. 5. 1) H2 2) PPI

17. . , . . . . , , , , , , . .

18. Step-up management : H2 brocker PPI Step-down management : PPI --> H2 brocker Maintenance treatment On-demand treatment

19. GERD Step 4: PPI twice daily+H2RA at bedtime PPI twice daily Step 3: PPI in A.M+H2RA at bedtime or PPI+Prokinetic agent PPI once daily (standard dose) Step 2: High dose H2RA or half dose PPI H2RA+Prokinetic agent H2RA or Prokinetic agent OTC (over-the-counter) H2RA Step 1: Life style modification

20. 1 (Step Up) History/Physical Exam : or H2 / H2 Or H2 PPI Step down : or

21. Alarming symptom, / 24 H2 PPI PPI PPI

22. GERD LA A

23. GERD LA B

24. GERD LA C

25. GERD LA D

26. ~

27. ( ) 1:30 ( ) 7:30 : 9:30 (TV ) 40

28. (66) 38 40-50 200-300 30

29. , . ( ~ ) , . . .( )

30. . . . ( )

31.