GE REFLUX AND ESOPHAGITIS Flashcards
mechanism of esophagitis?
transient LES relaxation
a hypotensive LES
anatomic disruption of GE junction
- laxity of diaphragm
- synergy of LES and diaphragm
- increased GEJ distensibility
additional factors affecting the mechanism of esophagitis?
decreased esophageal motility
hiatal hernia
obesity
pregnancy and exogenous estrogen
this is multifactorial condition involving retrograde flow of stomach contents into the esophagus, affects 20% of population, common mechanism is decreased LES tone
GERD
no mucosal injury is what type of GERD?
non erosive or erosive
non erosive GERD
mucosal erosions and develops in up to 1/3 of patients
erosive GERD
GERD symptoms?
dyspepsia and heartburn water brash globus odynophagia sore throat laryngitis hoarseness chronic cough wheezing dental erosions and gingivitis
new onset symptoms dysphagia, odynophagia bleeding anorexia persistent vomiting GI cancer in 1st degree relative
alarm features
ddx?
esophagitis:
- eosinophilic
- pill-induced
- infectious
esophageal motility disorders
- achalasia
- spasm
- scleroderma
PUD, gastritis, ZE syndrome
T/F, endoscopy required for diagnosis?
F, 2/3 patients will have normal findings with indications if there are:
erosive esophagitis
esophageal ulcer
barretts esophagus
esophageal stricture
these are important in the diagnosis of GERD via?
endoscopy
what detects acidic and non acidic reflux?
esophageal pH testing
GERD tx?
weight loss
stop caffeine, processed food
avoid tobacco
HOB elevation
*oral lozenges, chewing gum, abdominal breathing, avoid tight fitting garments
GI meds?
antacids
histamine 2 receptor antagonists
proton pump inhibitors
approach in tx of GERD?
lifestyle and dietary modification
antacids
H2 receptor antagonist
tradition to PPI
if erosive esophagitis how do we treat GERD?
lifestyle/diet mod
standard dose
taper PPI dose than transition to H2RAs
