Gastroesophageal Reflux Disease (GERD)

Question 1

Pertinent Physiology
The _________ plays a vital role in the frequency and severity of GERD

Answer 1

Lower Esophageal Sphincter

Question 2

True/False
Some degree of reflux is physiologic. Physiologic reflux episodes typically occur postprandially, are short-lived, asymptomatic, and rarely occur during sleep.

Answer 2

True

Question 3

Endoscopy demonstrates abnormalities in what fraction of patients?

Answer 3

one- third

Question 4

Pathophysiology
Pain associated with GERD is secondary to the

Answer 4

stimulation and activation of mucosal chemoreceptors by acid.

Question 5

What food exacerbate the symptoms of GERD

Answer 5

Spicy, acidic and salty foods
Alcohol also contribute to the onset of GERD

Question 6

What issue would you suspect?
(1) Heartburn occurs 30-60 minutes after meals and upon bending over or reclining.
(2) Patients often report relief from taking antacids or baking soda.
(3) Patients may complain of regurgitation (the spontaneous reflux of sour or bitter gastric contents into the mouth).
(4) Dysphagia occurs in one-third of patients and may be due to erosive esophagitis, abnormal esophageal peristalsis, or the development of an esophageal stricture.
(5) “Atypical” or “extraesophageal” manifestations of gastroesophageal disease may occur, including:
(a) Asthma,
(b) Chronic cough,
(c) Chronic laryngitis,
(d) Sore throat,
(e) Non-cardiac chest pain

Answer 6

GERD

Question 7

Symptoms of GERD may be similar to those of other diseases such as:

Answer 7

(a) Esophageal motility disorders,
(b) Peptic ulcer,
(c) Functional dyspepsia,
(d) Angina pectoris

Question 8

What are some complications of GERD?

Answer 8

Barrett Esophagus
Peptic Stricture

Question 9

What complication of GERD?
(a) This is a condition in which the squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium containing goblet and columnar cells (specialized intestinal metaplasia).
(b) Present in up to 10% of patients with chronic reflux, it arises from chronic reflux induced injury to the esophageal squamous epithelium.
(c) does not provoke specific symptoms, but gastroesophageal reflux does.
(d) Most patients have a long history of reflux symptoms, such as heartburn and regurgitation.
(e) The most serious complication of this is esophageal adenocarcinoma.
It is believed that most adenocarcinomas of the esophagus and many such tumors of the gastric cardia arise from dysplastic epithelium.

Answer 9

Barrett Esophagus

Question 10

What complication of GERD?
(a) Stricture formation occurs in about 5% of patients with esophagitis.
(b) It is manifested by the gradual development of solid food dysphagia progressive over months to years.
(c) Often there is a reduction in heartburn because the stricture acts as a barrier to reflux.
(d) Most strictures are located at the gastroesophageal junction

Answer 10

Peptic Stricture

Question 11

LABS for GERD

Answer 11

None

Question 12

RADS for GERD

Answer 12

Endoscopy- used in complicated patients

Question 13

TX for GERD
Mild, intermittent symptoms

Answer 13

(a) Lifestyle modifications:
1) Eating smaller meals
2) Elimination of acidic foods (citrus, tomatoes, coffee, spicy foods)
3) Elimination of foods that precipitate reflux (fatty foods, chocolate, peppermint, alcohol, cigarettes).
(b) Weight loss should be recommended for overweight patients.
(c) Patients with nocturnal symptoms should be advised to avoid lying down within 3 hours after meals, the period of greatest reflux, and to elevate the head of the bed on 6-inch blocks or a foam wedge to reduce reflux and enhance esophageal clearance.
(d) Antacids

Question 14

TX for GERD
Mild, intermittent symptoms
Patients with nocturnal symptoms should be advised to avoid lying down within how many hours after meals and why?

Answer 14

3 hours, the period of greatest reflux,

Question 15

True/False
PTs lower the head of the bed with 6-inch blocks or a foam wedge at the foot to reduce reflux and enhance esophageal clearance.

Answer 15

FALSE
ELIVATE THE HEAD OF THE BED

Question 16

What are the treatment of choice for troublesome symptoms?

Answer 16

Proton Pump Inhibitors (PPI)

Question 17

Proton Pump Inhibitors (PPI)
When taken for active heartburn, these agents have a delay in onset of at least ____ minutes.
However, once these agents take effect, they provide heartburn relief for up to __ hours.

Answer 17

30 Minutes
8 Hours

Question 18

Examples of PPI’s…
How should you dose them?

Answer 18

a) Omeprazole (Prilosec) 20 mg PO daily
b) Pantoprazole (Protonix) 20 mg PO daily
c) Esomeprazole (Nexium) 40 mg PO daily
Dosed daily, 30 minutes before breakfast, for 4-8 weeks

Question 19

Initial Care
What should be the basis of treatment for GERD

Answer 19

Emphasis on eliminating the causative factor

Question 20

True/False
Initial Care
Lifestyle modification could prove efficient in the treatment of GERD.

Answer 20

True

Question 21

When to Refer
(a) Patients with typical GERD whose symptoms do not resolve with maximum empiric management with ______ months of twice-daily proton pump inhibitor therapy.
(b) Patients with significant ______ or other alarm symptoms for upper endoscopy (e.g. weight loss, bleeding, hoarseness or voice changes, chronic cough of nonpulmonary, allergic or cardiac causes).
(c) Patients with Barrett esophagus or esophageal stricture for endoscopic surveillance.
(d) Patients who have Barrett esophagus with ____________.

Answer 21

a) three months
b) dysphagia
d) dysplasia or early mucosal cancer

Question 22

What are contraindications for PPI’s

Answer 22

Hypersensativity, renal or hepatic impairment