E1: GERD Flashcards
What are the possible complications of GERD?
- Barretts esophagus
- Erosive esophagitis
- Strictures
- esophageal cancer
What is it called when the lower esophageal sphincter is relaxed, allowing backflow of stomach contents?
GERD
What are the extraesophageal manifestations of GERD?
- Bronchospasm/wheezing
- Larngitis
- chronic cough
- loss of dental enamel
What medications decrease the LES pressure?
Anticholinergics, TCAs, CCBs, nitrates, and narcotics
What drugs can injure the GI mucosa?
-Bisphosphonates, Iron supplements, NSAIDs, potassium, tetracycline
What is the most common type of Hiatal hernia?
Sliding hernia
What will you see on CXR of a patient with a hiatal hernia?
A retro cardiac mass with or without an air fluid level
What is the best diagnostic study to evaluate mucosal injury?
EDG
What is the treatment of GERD?
- Lifestyle: Elevate head of bed, weight loss, selective elimination of triggering food
- Medication: Tums, PPIs, H2 blockers
- Anti-reflux surgery
What is the treatment of mild/intermittent GERD?
-Lifestyle modification, H2 blockers, and antacids
What is the treatment of GERD with severe symptoms?
-PPI daily x 8 weeks and lifestyle modification
How do H2 blockers treat GERD?
They block histamine at H2 receptors of gastric parietal cells, which leads to decreased secretion of stomach acid
How do PPIs treat GERD?
They reduce the amount of acid being produced by glands in the stomach
-take 30 minutes before the first meal of the day
What are the possible complications of long term PPI use?
- Risk of infection (acidic environment is protective)
- Malabsorption: Mg, B12, calcium, iron
- *Check Mg periodically
How long should a patient with GERD be on medication if they do not have severe erosive esophagitis and Barrett’s esophagus?
-They should have the lowest dose and shortest duration appropriate and discharge meds completely in patients without symptoms
How should patients with GERD and severe esophagitis or Barretts esophagitis be treated?
They require maintenance acid suppression with a PPI
What are the indications for surgical management of GERD?
- Failed optimal medical management
- GERD complications (barretts)
- Noncompliance
What is the most common cause of esophagitis?
GERD
What is Barrett’s esophagus?
When squamous epithelium in the distal esophagus is replaced with columnar epithelium
What is a patient with Barrett’s esophagus at increased risk for?
Adenocarcinoma
What is the treatment of Barrett’s esophagus?
- Indefinite use of PPI
- EDG surveillance to detect evidence of dysplasia
- Endoscopic eradication therapy
What are the two main types of esophageal cancer?
Adenocarcinoma and squamous cell carcinoma
What are the risk factors for esophageal adenocarcinoma?
Barretts, smoking, and obesity
What are the risk factors for esophageal squamous cells carcinoma?
Smoking, ETOH, diet low in fruits/vegetables, caustic esophageal injury, and nutritional deficiencies
What test us recommended in all patients with dysphagia?
EGD
If a patient has DM, asthma, and recent ABx use, what kind of esophagitis are they at increased risk for?
Infectious (candida)
If a patient has asthma, rhinitis, food allergies, and chronic eczema, what kind of esophagitis are they at increased risk for?
Eosinophilic esophagitis
What is it called when there is high pressure contractions in the esophagus and normal relaxation of the esophagogastric junction?
Hypercontractile (jackhammer) esophagus
How is hypercontractile esophagus diagnosed?
DES manometry
What is the treatment of Hypercontractile esophagus?
Control GERD and relax hypercontractile smooth muscle (PPI, CCB)
If a patient has aperistalsis on manometry and birds beak on the barium esophagram, what should you be concerned about?
Achalasia
What causes achalasia?
Progressive inflammation and degeneration of esophageal neurons
What are the symptoms of achalasia?
Dysphagia, regurgitation, difficulty belching, CP, and heart burn
How is achalasia diagnosed?
- Manometry is required
- EGD necessary to r/o CA
- Barium swallow: dilation of esophagus and birds beak
What is the treatment of achalasia?
- Mechanical disruption of LES muscle fibers (pneumatic dilation and heller myotomy- incision into the muscles of the LES)
- Biochemical reduction in LES pressure
What is Mallory Weiss syndrome?
-mucosal laceration in distal esophagus and proximal stomach
What are the predisposing factors of Mallory Weiss syndrome?
Heavy alcohol use and hiatal hernia
What is the treatment of Mallory Weiss syndrome?
- Stabilize patient
- PPI
- endoscopic bleeding control if it doesn’t stop on its own
- address other predisposing factors
What medications can be used in achalasia to biochemically reduce the LES pressure?
Botulinum toxin, nitrates, and CCBs
