General Surgery/GIT / Gastroesophageal Reflux Disease

Question 1

What is gastroesophageal reflux disease (GERD)?

Answer 1

Pathologic reflux of acidic contents from the stomach into the esophagus causing symptoms or complications

Question 2

What is physiologic reflux?

Answer 2

Reflux occurring after eating, for only short periods of time, and causing no symptoms

Question 3

What is reflux esophagitis?

Answer 3

GERD along with esophageal inflammation on endoscopy or biopsy

Question 4

What pathophysiologic factors may contribute to GERD?

Answer 4

• decreased resting tone of the lower esophageal sphincter
• impaired clearance of acid from the esophagus
• decreased mucosal protective mechanisms

Question 5

What symptoms do patients with GERD typically complain of?

Answer 5

• heartburn
• regurgitation of acidic material
• dysphagia

Question 6

When do symptoms of GERD typically occur?

Answer 6

• After meals and when lying supine

Question 7

What are some atypical symptoms of GERD?

Answer 7

• chest pain
• water brash (hypersalivation)
• odynophagia
• nausea
• asthma
• laryngitis
• cough

Question 8

What is the differential diagnosis of GERD?

Answer 8

• esophageal motility disorders
• infectious esophagitis
• pill esophagitis
• coronary artery disease
• gastritis
• peptic ulcer disease
• nonulcer dyspepsia
• biliary tract disease

Question 9

How are most cases of GERD diagnosed?

Answer 9

• clinical history and a therapeutic response to an antireflux regimen of lifetyle and dietary modifications and/or acid suppression medication

Question 10

When should you consider including endoscopy in your diagnostic workup?

Answer 10

• odynophagia
• bysphagia
• weight loss
• early satiety
• bleeding
• symptoms refractory to treatment

Question 11

Who is a candidate for a 24-hour ambulatory esophageal pH monitoring?

Answer 11

No response to empiric medication and no evidence of inflammation on endoscopy

Question 12

What are the complications of GERD?

Answer 12

• esophagitis
• esophageal ulcers
• strictures
• Barrett esophagus
• iron-deficiency anemia
• extraesophageal manifestations such as asthma, cough, and laryngitis

Question 13

What is Barrett esophagus?

Answer 13

• Metaplasia from squamous to columnar epithelium in the lower esophagus resulting from chronic reflux

Question 14

When should endoscopic surveillance for Barrett esophagus be considered?

Answer 14

Symptoms for longer than 5 years

Question 15

Barrett esophagus puts patients at increased risk for what malignancy?

Answer 15

Adenocarcinoma of the esophagus in 10% of patients

Question 16

Dietary modifications for the management of GERD

Answer 16

• Avoid large meals
• avoid eating for 2-3 hours prior to reclining
• avoid chocolate, cola, alcohol, coffee, and fatty food intake

Question 17

Life style modifications for the management of GERD

Answer 17

• Elevate the head of the bed
• weight loss (if obese)
• smoking cessation

Question 18

Medications that may contribute to reflux

Answer 18

• oral bisphosphonates
• calcium-channel blockers
• anticholinergics
• sedatives
• theophylline

Question 19

Drug therapy to reduce acid

Answer 19

• antacids
• H2-blockers
• proton pump inhibitors (PPI)

Question 20

What are the indications for antireflux surgery (Nissen fundoplication, etc)?

Answer 20

• persistent or recurrent symptoms refractory to medical management
• severe esophagitis
• Barrett esophagus
• stricture
• recurrent aspiration or pneumonia associated with GERD