Approach to upper GI symptoms

Question 1

most common UGI symptoms (3)

Answer 1

heartburn (acid reflux/GERD). dysphagia (difficulty swallowing). dyspepsia (epigastric pain related to eating)

Question 2

common symptoms of GERD

Answer 2

burning, substernal pain. radiation of acid sensation from stomach to mouth. acid taste in mouth. chest pain. nausea. waterbrash (hypersalivation)

Question 3

3 major risk factors for GERD

Answer 3

reduced LES pressure. hiatus hernia. obesity

Question 4

factors that lower LES pressure

Answer 4

alcohol, nicotine, dietary fat, peppermint, meds (narcotics, Ca channel blockers). hormones (estrogen -pregnancy, glucagon)

Question 5

hiatus hernia: normal state vs. hiatus hernia

Answer 5

normal: LES at level of diaphragm. hiatus hernia: part of stomach herniates into chest through diaphragm so LES is above diaphragm = pressure is reduced

Question 6

paraesophageal hernia

Answer 6

needs surgical approach vs. hiatus hernia which you can treat medically: when LES is normally placed, but part of stomach fundus is pinched beside the esophagus = can twist and be ischemic or perforate

Question 7

outcomes of reflux

Answer 7

GERD (interferes with QoL, esophageal erosions). stricture. barrett’s esophagus. adenocarcinoma. non cardiac chest pain. extra-esophageal symptoms like chronic cough, asthma exacerbation.

Question 8

Barrett’s esophagus

Answer 8

metaplasia where normal squamous lining in esophagus turns into simple columnar; risk factor for adenocarcinoma (normally looks pale, now looks dark pink)

Question 9

most common type of esophageal cancer? cause?

Answer 9

esophageal adenocarcinoma - almost always from a segment of Barrett’s Esophagus

Question 10

diagnosis of GERD? when is diagnostic testing indicated?

Answer 10

diagnostic tests usually not required; with typical history + response to therapy. diagnostic testing indicated for: severe or atypical symptoms + poor response to therapy.

Question 11

2 diagnostic tests for GERD

Answer 11

endoscopy: for erosions, barrets, stricture, and to exclude other diagnosis. 24hr esophageal pH recording - to look at degree of acid exposure + correlate with symptoms

Question 12

GERD treatment - lifestyle

Answer 12

avoid eating foods that cause symptoms and 4 hrs before bed; smoking, elevate head of bed; weight loss; don’t wear tight fitting clothes

Question 13

medical therapy of GERD

Answer 13

over the counter antacids like tums, maalox. H2 blockers. PPIs like omeprazole, lansoprazole

Question 14

surgical therapy for GERD

Answer 14

fundoplication: usually done laparoscopically

Question 15

3 types of dysphagia

Answer 15

oropharyngeal. esophageal mechanical. esophageal motor

Question 16

disordered oropharyngeal swallowing: 4

Answer 16

difficulty initiating swallow, nasopharyneal regurg, pulm. aspiration, sensation of residual food there

Question 17

causes of dysphagia

Answer 17

oropharyngeal: strokes, MS, myathenia gravis, myopathies. esophageal motor: achalasia, severe GERD. esophageal mechanical: benign strictures, Schatzke’s ring, neoplasia

Question 18

symptoms of oropharyngeal dysphasia

Answer 18

unable to initiate swallow. coughing/choking with liquid bolus. repeated throat clearing. nasal regurg of liquids. other neuro symptoms

Question 19

symptoms of esophageal: mechanical vs. motor

Answer 19

mechanical: subacute onset, progressive, constant, solids > liquids, regurgitate bolus, not temp sensitive. motor: gradual, not progress., intermittent, liquids > solids, valsalva maneuver will drive food down, temp sensitive

Question 20

investigations for dysphagia

Answer 20

oroph: neuro exam, cine swallow (xray of pt swallowing). esophageal mechanical: barium swallow, endscopy. esophageal motor: barium swallow, manometry