Gastroesophageal Reflux Flashcards

1
Q

Mechanism of GER?

A

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

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2
Q

age of peak GER and resolution

A

peak: 4-6 mo

<20% have GER 12-15 mo

> 2 years–> unlikely to resolve

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3
Q

Extra-esophageal association of GERD

A
  1. sinusitis
  2. laryngitis
  3. chronic cough
  4. pneumonia/bronchiectasis
  5. dental erosions
  6. irritability

NOT associated with ALTE

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4
Q

Pediatric population at risk of chronic GERD?

A
  1. neurological disorders
  2. obesity
  3. EA/TEF post repair
  4. Hiatal hernia
  5. achalasia
  6. obesity
  7. CF
  8. Post lung transplantation
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5
Q

Testing for reflux, what would you order?

A
  1. UGI contrast study–> r/o anatomic abnormalities
  2. pH meter
  3. Multichannel intra-luminal impedance (pH-MII)
  4. Manometry –> assess for achalasia vs rumination
  5. EGD + Biopsy
  6. nuclear scintigraphy –> not recommended, but may detect GERD mimickers
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6
Q

Role of pH-MII?

A

-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

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7
Q

Role of pH meter?

A

-assess efficacy of anti-acids
-differentiates btw eosinophilic vs erosive esophagitis

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8
Q

Life style modifications in infants?

A
  1. Trial of extensively hydrolyzed formula (2-4) wk
  2. Thicken feeds (dec regurg but not reflux)
  3. prone position (dec reflux but inc SIDS)
  4. Lt sided superior to Rt side position
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9
Q

Life style modifications in adolescents?

A
  1. NO evidence for food elimination
  2. WT loss in obesity
  3. Avoid late night meals
  4. Lt sided superior to Rt side position
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10
Q

Risks of PPI?

A
  • inc resp and GI infections
  • hip/spine fractures
  • IDA
  • hypomagnesemia
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11
Q

Indications for fundoplication?

A

-Severe GERD unresponsive to PPI
-Failure, dependancy, non-adherance on medical therapy
- recurrent aspiration
- recurrent GIB

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12
Q

side effects of fundoplication?

A
  1. gas bloating syndrome
  2. dysphagia
  3. pooling of secretions –> aspiration/retching
  4. failure and need for redo
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13
Q

what is Barrett’s esophagus?

A

Change for normal squamous cell epithelium with metaplasic columnar epithelium

Increase risk of adenocarcinoma
Adults: risk from high grade dysplasia to CA 6%

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14
Q

Adult screening for barrett’s ?

A

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

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