Gastroesophageal Reflux Disease Flashcards

1
Q

What scale is used to grade erosive esophagitis?

A

The Los Angeles grading system, which is a 4 pt. scale going from A-D

The Los Angeles Grading System is the most thoroughly evaluated esophagitis classification tool and is gaining acceptance in the United States and Europe as a standard to gauge the extent of EE in patients undergoing upper endoscopy

Upper endoscopic findings of esophagitis are 90%-95% specific to GERD and are the clinical standard for determining the extent of esophagitis and excluding other causes of the patient’s acid reflux symptoms. Only 20%-60% of patients with acid esophageal reflux found in pH testing are found to have endoscopic findings consistent with esophagitis

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2
Q

T or F. The Los Angeles grade has no correlation to the severity of heartburn symptoms

A

T. Grade D may have mild heartburn and A may have terrible symptoms

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3
Q
A
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4
Q

What if you perscribe a PPI to someone with gastric reflux and after taking it as directed, the pt. doesnt see any relief?

A

Dont up the dose- your diagnosis is wrong and something else besides gastric reflux is going on

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5
Q

Men with chronic GERD symptoms need an endoscopy to exclude progression/occurrence of Barrett’s esophagus. Women DO NOT- Barrett’s is almost exclusively a male disease

A

So the pt. with GERD will be scoped, graded on the LA system, adviced not to smoke, and most likely started on a PPI (take before eating in the morning)

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6
Q

Really all you need for reflux diagnosis is eosinophils or EO granules- everything else is just helpful. But again most ppl with suspected GERD are not scoped

A

Normal Esophagus Epithelium

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7
Q
A

Heartburn can lead to cancer in the sense that it can lead to Barrett’s esophagus, which is the major precursor to adenocarcinoma (almost exclusive to men)

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8
Q
A

A.

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9
Q
A
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10
Q

GERD is usually a symptom based diagnosis without the need for endoscopy to diagnose (endoscopy is typically normal in these pts.- i.e. no erosive esophagitis)

A

If you endoscope someone and find erosive esophagitis, youve made the diagnosis of GERD and no further imaging is needed. But again, most pts. with heartburn/GERD have a normal endoscopy anyways so its not necessary

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11
Q

So what are the main indications for endoscopy?

A

You wouldnt normally use endoscopy for diagnosis of GERD but may want to for:

  • evaluating other symptoms such as dysphagia
  • to rule other things such as eosinophilic esophagitis
  • screen for Barrett’s esophagus
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12
Q

What is eosinophilic esophagitis (EoE)?

A

This is an allergic inflammatory condition (also known as allergic esophagitis) predominantly of young males characterized by a history of atypical heartburn, intermittent dysphagia, food impaction, vomiting, and often trouble finishing meals due to pain

Food allergy may play a role. Many people with EoE have other autoimmune and allergic disease. This includes asthma and celiac disease.

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13
Q

How does the esophagus look on endoscopy with EoE? Biopsy?

A

it will take on a ringed appearance (O shaped) with linear furrows and narrow caliber lumen. Eosinophils are inflammatory cells that release a variety of chemical signals which inflame the surrounding esophageal tissue. This results in the signs and symptoms of pain, visible redness on endoscopy, and a natural history that may include stricturing

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14
Q

How should suspected EoE be treated?

A

start them on a PPI (if they respond the diagnosis is PPIrEE) and if not, they may need topical/swallowed steroids (diagnosis is EoE)

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15
Q
A
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16
Q

EoE- The diagnosis is made via biopsy with 15+ eosinophils/hpf

A
17
Q
A

Note that the diagnosis of Barrett’s esophagus can only be made with endoscopy and has to be confirmed histologically with biopsy.

The distal esophagus should be whiteish-grey colored

18
Q

What is the tx for Barrett’s esophagus?

A

there is no direct tx. so the tx is the treat is underlying reflux

19
Q
A
20
Q

Again, what is the pt. population for barrett’s esophagus?

A

usually older, white men with obesity

21
Q
A
22
Q

probably wont get a path report that says the diangosis is Barrett’s, you will get intestinal metaplasia most likely

A

Barretts metaplasia is protective- want to see columnar cells and goblet cells to make the diagnosis

23
Q

The nuclei moving toward the lumen suggests abnormal maturation in low-grade metaplasia

What are the major differences on biopsy between Barrett’s metaplasia and the onset of dysplasia (which may suggest eminent transition into cancer)?

A

Barrett’s is marked by the appearance of goblet cells, columnar cell metaplasia, and some hyperchromasia, while

dysplasia is marked by failure of epithelial cells to mature, increased hyperchromasia, and **abnormal architecture* of glands (might still see goblet cells in low-grade dysplasia but very hard to differentiate)

24
Q

For something to be metastatic via lymphatics in the GI, what layer must it reach?

A

the submucosa (this is not real lymph in the lamina propria)

25
Q

What mutation is involved in progression of Barrett’s to dysplasia?

A

p53

26
Q
A
27
Q
A
28
Q

What are the two main types of esophageal cancers?

A

adenocarcinoma and SCC

29
Q
A
30
Q

What kind of esophageal cancer is this?

A

Adenocarcinoma

31
Q

What kind of esophageal cancer is this?

A

SCC

32
Q

What is the common pt. pop for esophageal SCCs?

A

AA (8x) males (4:1 to females) over the age of 45

33
Q

T or F. Esophageal adenocarcinoma is most common in white people

A

T.

34
Q

What are the risk factors for esophageal SCC?

A

Alcohol and tobacco use,

poverty,

caustic esophageal injury,

achalasia (failure of smooth muscle fibers to relax, which can cause a sphincter to remain closed and fail to open when needed)

mediastinal radiation (delayed)