General Surgery/GIT / Gastroesophageal Reflux Disease Flashcards
What is gastroesophageal reflux disease (GERD)?
Pathologic reflux of acidic contents from the stomach into the esophagus causing symptoms or complications
What is physiologic reflux?
Reflux occurring after eating, for only short periods of time, and causing no symptoms
What is reflux esophagitis?
GERD along with esophageal inflammation on endoscopy or biopsy
What pathophysiologic factors may contribute to GERD?
- decreased resting tone of the lower esophageal sphincter
- impaired clearance of acid from the esophagus
- decreased mucosal protective mechanisms
What symptoms do patients with GERD typically complain of?
- heartburn
- regurgitation of acidic material
- dysphagia
When do symptoms of GERD typically occur?
- After meals and when lying supine
What are some atypical symptoms of GERD?
- chest pain
- water brash (hypersalivation)
- odynophagia
- nausea
- asthma
- laryngitis
- cough
What is the differential diagnosis of GERD?
- esophageal motility disorders
- infectious esophagitis
- pill esophagitis
- coronary artery disease
- gastritis
- peptic ulcer disease
- nonulcer dyspepsia
- biliary tract disease
How are most cases of GERD diagnosed?
- clinical history and a therapeutic response to an antireflux regimen of lifetyle and dietary modifications and/or acid suppression medication
When should you consider including endoscopy in your diagnostic workup?
- odynophagia
- bysphagia
- weight loss
- early satiety
- bleeding
- symptoms refractory to treatment
Who is a candidate for a 24-hour ambulatory esophageal pH monitoring?
No response to empiric medication and no evidence of inflammation on endoscopy
What are the complications of GERD?
- esophagitis
- esophageal ulcers
- strictures
- Barrett esophagus
- iron-deficiency anemia
- extraesophageal manifestations such as asthma, cough, and laryngitis
What is Barrett esophagus?
- Metaplasia from squamous to columnar epithelium in the lower esophagus resulting from chronic reflux
When should endoscopic surveillance for Barrett esophagus be considered?
Symptoms for longer than 5 years
Barrett esophagus puts patients at increased risk for what malignancy?
Adenocarcinoma of the esophagus in 10% of patients
Dietary modifications for the management of GERD
- Avoid large meals
- avoid eating for 2-3 hours prior to reclining
- avoid chocolate, cola, alcohol, coffee, and fatty food intake
Life style modifications for the management of GERD
- Elevate the head of the bed
- weight loss (if obese)
- smoking cessation
Medications that may contribute to reflux
- oral bisphosphonates
- calcium-channel blockers
- anticholinergics
- sedatives
- theophylline
Drug therapy to reduce acid
- antacids
- H2-blockers
- proton pump inhibitors (PPI)
What are the indications for antireflux surgery (Nissen fundoplication, etc)?
- persistent or recurrent symptoms refractory to medical management
- severe esophagitis
- Barrett esophagus
- stricture
- recurrent aspiration or pneumonia associated with GERD
