ermahGERD lecture Flashcards
What are some important clinical presentations of GERD? (around 10 of them)
- pyrosis (heartburn)
- water brash (increased salivation)
- chest pain (can mimic CAD)
- worse w. laying supine
- nocturnal coughing (also causing a change in voice)
- wheezing/ asthma
- dysphagia (difficulty swallowing)
- odynophagia (painful swallowing)
- GI bleeding (hematemesis)
- tarry black stools
What is the major underlying mechanism of GERD?
decrease in lower esophageal sphincter tone
What foods/drinks/exposures makes GERD worse? (aka relax LES)
caffeine, chocolate, fatty foods (“ice cream helps before bed”), ALCOHOL, smoking, peppermint, and many other prescription drugs
Why do preggo’s and obese people get GERD?
increased in intraabdominal pressure
What are the 3 histological criteria for diagnosing GERD via biopsy of LES?
1) epithelial inflammation - w/ neutrophils and eosinophils
2) elongation - of lamina propria papillae extending into the upper 1/3 of the epithelium
3) basal cell hyperplasia - >20% of the total thickness of epithelium
What is the pathology buzzword for the change that occurs in Barrett’s Esophagus?
METAPLASIA (aka change in cell type from the cell that normally resides in a given location)
What is the metaplasic change that occurs in Barrett’s Esophagus? and what does it leave you at an increased risk for?
replacement of non-keratinized, stratified squamous epithelium (normal to the esophagus) in the distal esophagus w/ non-ciliated columnar cells w. goblet cells (goblet cells are a huge clue on histo) (these columnar cells are normal to the intestine)
leaves you at an increased risk for: esophagitis, esophageal ulcers, and ADENOCARCINOMA!!!
What is required for diagnosis of Barretts esophagus?
1) admixed goblet cells (therefore intestinal lookiing epithelium)
2) endoscopic abnormality
* BOTH REQUIRED for a dx of B.E.*
Why should you routinely screen GERD patients?
Because they are at in increased risk of B.E…. even B.E. has a “dysplastic” form that appears prior to becoming adenocarcinoma…
What is the most common complaint of a pt with adenocarcinoma?
Dysphagia and weight loss
What is diagnostic of adenocarinoma and what gives it a good or bad prognosis?
GLAND formation and MUCIN production identify a malignancy as adeoncarcinoma…
More glands & Mucin = more differentiated = better prognosis
Fewer glands & more solid appearance = poorly differentiated = poor prognosis
Treatment options for GERD?
Mild = elevate head at night, chew gum, lose weight, restrict alcohol/stop smoking
Mod–> severe: H2 blockers or PPI’s;
special treatments = endoscopic mucosal resection (EMR), UV therapy (older treatment), radiofrequency ablation (removes columnar cells to regrow squamos)
How does squamous cell carcinoma of esophagus differ from adenocarcinoma? (ie location, risk factors)
Pathogenesis: chronic esophagitis –> increased cell turnover –> inflammation –> dysplasia –> cancer
Alcohol & tobacco use = biggest risk factors!, HPV infection also big… hot beverage consumption (IRAN)
Occurs in middle 1/2 to upper 1/3 of esophagus vs adeno which was distal 1/3
African mericans more likely than whites to get it
males more likey than females
What is eosinophilic esophagitis?
sort-of allergic reaction to particular foods… presents w/ dysphagia, children may have feeding difficulties or GERD-like symptoms. “everytime I eat strawberries my throat itches”
Unique endoscopy = “linear furrowing” and “stacked circles”, proximal strictures
Histo shows >15-25 eosinophils per high power field
What is esophagitis and what causes it?
Anything that leads to inflammation then ulceration then necrosis ie:
- irritants: smoking, alcohol, pills
- infections (esp in immunocompromised): Candida w/ yeast buds and hyphae… HSV & CMV: nuclear inclusions
- iatrogenic: doxycycline, radiation, chemo, GVHD
- disease: Crohn’s
