Esophagitis/GERD Flashcards
What is the MCC of Esophagitis?
GERD
What is the MCC of Esophagitis in Immunocompromised patients?
Candida
CMV
HSV
Which medications can cause esophagitis?
- NSAIDS
- BB
- CCB
- Bisphosphonates
- Vitamin C
- Iron supplements
- Potassium Cl
What are some risk factors to Esophagitis?
- Pregnancy
- ETOH use
- Smoking
- Chocolate
- Spicey food
What is the best way to diagnose Esophagitis?
Upper endoscopy
A patient’s upper endoscopy revealed linear yellow-white plaques. How would you manage this patient?
Candida:
PO Fluconazole 1st line
-Voriconazole; Caspofungin 2nd line
A patient’s upper endoscopy revealed small, deep ulcers. How would you manage this patient?
HSV:
Acyclovir 1st line
-Foscarnet 2nd line
A patient’s upper endoscopy revealed large superficial shallow ulcers. How would you manage this patient?
CMV:
Gangcylovir 1st line
–Valganciclovir; Foscarnet 2nd line
Which esophagitis is associated with multiple corrugated rings seen on endoscopy?
Eosinophilic esophagitis
How do you manage a child with eosinophilic esophagitis?
- Remove foods that incite an allergic response
- Inhaled corticosteroids WITHOUT a spacer
How would you manage a patient with pill-induced esophagitis?
- Instruct patient to take pills with at least 4 ounces of water
- avoid recumbency for at least 30-60 min after taking their pills
A patient has ingested drain cleaner on accident and is suffering from Caustic esophagitis. What is the next best step in managing this patient?
Endoscopy is used to determine the extent of damage and to look for complications: perforation, stricture, esophageal fistula
A patient has ingested drain cleaner on accident and is suffering from Caustic esophagitis. What is the best management for this patient?
Supportive, pain medications, IV fluids
What are some alarm sxs in GERD patients?
- Dysphagia
- Odynophagia
- Weight loss
- Bleeding
What is the gold standard for diagnosing GERD?
24 Hr ambulatory monitoring
What the best initial test used for diagnosing GERD?
Endoscopy
What does an Esophageal manometry reveal for a patient with GERD?
Decreased LES pressure
What is Stage 1 in managing GERD?
LIfestyle modifications:
- Elevation fo the head of the bed by 6 inches
- Avoid for 3 hours after eating
- Eat small meals
- Avoid certain foods
- Decrease fat and ETOH intake
- Weight loss
- Smoking cessation
What is Stage 2 in managing GERD?
“As needed” pharmacological therapy:
- Antacids and OTC H2 receptor blockers
- If there are alarm sxs, an upper endoscopy is the next step
What is Stage 3 in managing GERD?
Initiation of scheduled pharm therapy:
- H2RA
- PPI & prokinetic agents (Cisapride)
*PPI are the DOC in moderate-severe disease
What is the management in refractory GERD?
Nissen fundoplication
What is the DOC in moderate-severe GERD?
PPIs