Esophagus 1

Question 1

Most common causes of GERD?

Answer 1

Weak LES; increased transient LES relaxations

Question 2

Demeester score - Based on which test? Abnormal cut off?

Answer 2

PH monitoring; greater than 14.7

Question 3

PH monitoring - normal acid exposure time? Abnormal?

If symptomatic but normal exposure time, differential?

Answer 3

<4% ; >6%

Reflux hypersensitivity vs functional heartburn ; GERD

Question 4

Symptom index versus symptom sensitivity index? (Abnormal threshold?)

Answer 4

Reflux related symptoms episodes/total SYMPTOM episodes (>50%)

Reflex related symptoms episodes/total REFLUX episodes (>10%)

Question 5

Medication more potent than traditional PPIs? Mechanism?

Answer 5

Vonoprazan

Potassium competitive acid blocker (blocks potassium’s ability to engage in ATPase)

Question 6

Stretta?

Answer 6

Endoscopic radiofrequency non-ablative therapy for GERD

Mechanism unclear

Question 7

EsophyX?

Answer 7

Endoscopic fundoplication

Question 8

Refractory GERD - definition?

Answer 8

Persistent heartburn (2+ times/week for three months) despite twice daily PPI

Question 9

Patient with borderline acid exposure time on pH testing – can still diagnosis GERD if?

Answer 9

Abnormal esophageal biopsy
Abnormal impedance
Positive reflux-symptom association
Frequent reflux episodes>40

Question 10

Reflux hypersensitivity vs functional heartburn?

Answer 10

Physiologic acid exposure time under 4% WITH positive reflux symptom association

Physiologic acid exposure time under 4% WITHOUT positive reflux symptom association (and normal manometry)

Question 11

Use of baclofen for this esophageal disease?

Mechanism?

Answer 11

Non-acid reflux with regurgitation

Decreases transient lower esophageal sphincter relaxations (GABA receptor agonist)

Question 12

Intestinal metaplasia of under 1 cm that replaces the normal stratified squamous epithelium?

1+ cm?

Answer 12

Specialized intestinal metaplasia of the GE junction

Barrett’s esophagus

Question 13

Historical annual incidence of esophageal adenocarcinoma?

In the long segment Barrett’s without high grade dysplasia? With high grade dysplasia? (Definition of long segment)

Answer 13

0. 5% per year

0. 7% per year; 7% year (3 cm)

Question 14

Who should get screened for Barrett’s esophagus?

Answer 14

Men with GERD symptoms for 5+ years and 2+ of:

• age>50
• white
• central obesity
• smoking history
• relative with Esophageal adenocarcinoma

Question 15

Difference in biopsies for dysplastic versus non-dysplastic Barrett’s?

Answer 15

q2 vs q1 cm biopsies

Question 16

Management for Barrett’s esophagus with:

No dysplasia
Indefinite for dysplasia

Answer 16

EGD q3-5 years

optimize PPI therapy and repeat EGD in 3-6 months

Question 17

Dx and management for Barrett’s esophagus with:

Low-grade dysplasia

High-grade dysplasia

Answer 17

Confirm with repeat EGD within 3-6 months
TX: EGD every year until no dysplasia on two exams OR endoscopic ablation or EMR (If nodular dysplasia)

Confirm with EGD within three months
Tx: Endoscopic ablation or EMR (if nodular dysplasia)

Question 18

Dx and management for Barrett’s esophagus with:

Esophageal Adenocarcinoma (T1a)

Submucosal esophageal adenocarcinoma (T1b)

Answer 18

Tumor invades lamina propria or muscularis mucosa
Tx: EMR and ablation

Tumor invades submucosa
Tx: EMR and ablation if low risk features (otherwise esophagectomy)

Question 19

Low risk features for T1b submucosal esophageal adenocarcinoma?

Answer 19

Less than 500 mm invasion into the submucisa

good to moderate differentiation

absence of lymphatic invasion

Question 20

Recurrence rate of Barrett’s esophagus after radio frequency ablation?

Answer 20

20-30% after 2 years

Question 21

Criteria for diagnosis of EoE?

Answer 21

1. Presence of esophageal symptoms
2. > 15 eosinophils per high-powered field or >60 per mm^3)
3. Absence of other causes of eosinophilia (GERD, Celiac’s, IBD, achalasia, vasculitis, Connective tissue disease)