Exam 1 - GERD Flashcards
What are four significant complications of GERD?
- Barrett’s esophagus
- Erosive esophagitis
- Strictures
- Esophageal cancer
What is the general pathphysiology of GERD?
Lower esophageal sphincter (LES) transiently relaxes, allowing back flow of stomach contents causing troublesome symptoms or complications
What is the hallmark symptom of GERD?
Heartburn (pyrosis) typically post-prandial
What are some extraesophageal manifestations of GERD?
- Bronchospasm/Wheezing
- Laryngitis/Hoarseness
- Chronic cough
- Loss of dental enamel
Other than heartburn, what are some other symptoms of GERD?
- Chest pain which may mimic angina (squeezing, substernal, radiates)
- Dysphagia
- Water brash or hypersalivation
- Globus sensation (lump in throat)
- Odynophagia
- Nausea
If a patient presents with dysphagia, what should you rule out in addition to GERD?
Stricture
What etiologies can worsen GERD?
- Obesity
- Gravity
- Pregnancy
- Foods
- Medication
What medications can increased GERD symptoms by decreasing LES pressure?
- Anticholinergics (Ditropan)
- Tricyclic Antidepressants (Amitriptyline)
- CCB
- Nitrates
- Narcotics
What medications can increased GERD symptoms by injuring the esophageal mucosa?
- Bisphosphonates (Fosamax, Actonel)
- Iron supplements
- NSAIDs/Aspirin
- Potassium
- Tetracycline
What is a hiatal hernia?
What are the two types and which is more common?
Portion of the stomach enters above the diaphragm into the chest.
- Sliding hernia (more common)
- Paraesophageal hernia
What are symptoms associated with a hiatal hernia?
Most are asymptomatic and an incidental findings, but they can cause symptoms of GERD
What x-ray finding is consistent with a hiatal hernia?
Retrocardiac mass with or without an air-fluid level
What diagnostic study is best to evaluate for esophageal mucosal injury?
EGD
If you wanted to observe the transit of a food bolus, what diagnostic test would you order?
Esophageal impedance testing
If you wanted a test with high sensitivity for detecting and quantifying reflux, and allowed patients to log symptoms, what diagnostic test would you order?
Esophageal pH monitoring
If you wanted to measure the function of the LES and peristalsis, what diagnostic test would you order?
Esophageal manometry
Is a barium contrast esophagram typically used for diagnosis GERD? Why or why not?
Not typically used for diagnosis of GERD as it does not reliably identify mucosal injury.
What are some alarm features/red flags that require further workup and are not typical of GERD?
- Dysphagia
- Odynophagia
- Evidence of GI bleeding
- Unexplained weight loss
- Anemia
- Inadequate response to therapy
- New onset dyspepsia in pt 60 or older
- Prior anti-reflux surgery
- Personal hx of cancer
How is GERD diagnosed?
Clinical diagnosis with classic hx of GERD and no warning signs
Define mild/intermittent symptoms of GERD.
What is the recommended treatment?
Less than 1-2 episodes per week and no evidence of erosive esophagitis.
Step-up therapy: Lifestyle modification, H2 blockers (Ranitidine/Zantact), +/- Antiacids (TUMS)
Define severe symptoms of GERD.
What is the recommended treatment?
2 or more episodes per week with symptoms impairing quality of life.
Step down therapy: PPI + Lifestyle modifications then gradually decrease therapy
How do antacids work?
What are some examples?
Neutralize gastric pH
Ex: TUMS
How do H2 Blockers work?
What are some examples?
Block action of histamine at H2 receptors of gastric parietal cells, leading to decreased secretion of stomach acid
Ex: Ranitidine (Zantac), Famotidine (Pepcid)
How do PPIs work?
What are some examples?
Reduce the amount of acid produced by glands in the stomach; taken 30 minutes before 1st meal of the day
Ex: Omeprazole (Prilosec), Lansoprazole (Prevacid), Esomeprazole (Nexium), Pantoprazole (Protonix)
