Gastroesophageal Reflux Flashcards
Mechanism of GER?
Transient lower eso sphincter relaxation (TLESR) –> accounts for 90%
1.Not associated with swallowing or eso peristalisis
2. Increase with gastric distension
3. LES relaxation mediated vagally via brainstem
Note: N pressure btw 10-30mmHg and NOT LOW most GERD patients
age of peak GER and resolution
peak: 4-6 mo
<20% have GER 12-15 mo
> 2 years–> unlikely to resolve
Extra-esophageal association of GERD
- sinusitis
- laryngitis
- chronic cough
- pneumonia/bronchiectasis
- dental erosions
- irritability
NOT associated with ALTE
Pediatric population at risk of chronic GERD?
- neurological disorders
- obesity
- EA/TEF post repair
- Hiatal hernia
- achalasia
- obesity
- CF
- Post lung transplantation
Testing for reflux, what would you order?
- UGI contrast study–> r/o anatomic abnormalities
- pH meter
- Multichannel intra-luminal impedance (pH-MII)
- Manometry –> assess for achalasia vs rumination
- EGD + Biopsy
- nuclear scintigraphy –> not recommended, but may detect GERD mimickers
Role of pH-MII?
-Check if sx related to acid reflux
-Better than pH meter in patients with continuous feeds and max meds
-No normative peds data
-Add PSG to check if GERD causing apneas/ALTE
Role of pH meter?
-assess efficacy of anti-acids
-differentiates btw eosinophilic vs erosive esophagitis
Life style modifications in infants?
- Trial of extensively hydrolyzed formula (2-4) wk
- Thicken feeds (dec regurg but not reflux)
- prone position (dec reflux but inc SIDS)
- Lt sided superior to Rt side position
Life style modifications in adolescents?
- NO evidence for food elimination
- WT loss in obesity
- Avoid late night meals
- Lt sided superior to Rt side position
Risks of PPI?
- inc resp and GI infections
- hip/spine fractures
- IDA
- hypomagnesemia
Indications for fundoplication?
-Severe GERD unresponsive to PPI
-Failure, dependancy, non-adherance on medical therapy
- recurrent aspiration
- recurrent GIB
side effects of fundoplication?
- gas bloating syndrome
- dysphagia
- pooling of secretions –> aspiration/retching
- failure and need for redo
what is Barrett’s esophagus?
Change for normal squamous cell epithelium with metaplasic columnar epithelium
Increase risk of adenocarcinoma
Adults: risk from high grade dysplasia to CA 6%
Adult screening for barrett’s ?
No dysplasia –> e 3-5 yr
Low grade dysplasia –> e 6- 12 mo
High grade dysplasia –> e 3 mo
Evaluation: light endoscopy + 4 quadrants biopsy every 2cm and e 1c with dysplasia