GERD

Question 1

Explain the LA grading scale for Esophagitis.

Answer 1

Grade A: 1 or more mucosal breaks less than 5mm that does not extend between the tops of two mucosal folds

Grade B: 1 or more mucosal breaks more than 5mm that does not extend between the tops of two mucosal folds

Grade C: 1 or more mucosal breaks that extend between the tops of two mucosal folds but involve less than 75% of the esophageal circumference.

Grade D: 1 or more mucosal breaks that extend between the tops of two mucosal folds involving at least 75% of the esophageal circumference.

Question 2

How can GERD occur in patients with normal physiologic exposure to gastric contents and reflux?

Answer 2

These patients are called NERD patients. Non-erosive reflux disease. These patients produce less mucosal resistance in the distal esophagus.

Question 3

What is the most common cause of GERD in patients?

Answer 3

Ineffective esophageal clearance due to inefficient peristalsis, reduced salivary secretion, or reduced submucosal gland secretion.

Question 4

What is Barrett Esophagus?

Answer 4

Metaplasia of the stratified squamous cells in the distal esophagus to simple columnar cells due to acid exposure from reflux

Question 5

Main diagnostic tool for GERD.

Answer 5

Endoscopies can be normal even in patients with GERD. Testing the pH is the best method.

Bravo system checks pH. pH of less than 4 is considered GERD.

Question 6

How can Alginic Acid be used to treat GERD?

Answer 6

It ionizes to Alginate in stomach fluid forming a foam-like solid that acts as a barrier to prevent acid from entering the esophagus.

Question 7

Ranitidine, famotidine, nizatidine

Answer 7

Histamine receptor (H2) blockers used to decrease acid secretion to treat GERD.

(end it “-tidine”)

Question 8

omeprazole

Answer 8

Proton pump inhibitor (PPI) used to decrease acid secretion to treat GERD. More effective than H2RAs (H2 blockers).

(end it “-prazole”)

Question 9

Metoclopramide

Answer 9

MOA: sensitizes tissue to ACh to promote motility in the GI tract to improve esophageal clearance and/or treat GERD.

Question 10

Bethanechol

Answer 10

MOA: muscarinic agonist to promote GI motility and treat GERD.

Question 11

Tegaserod

Answer 11

MOA: binds to 5-HT4 (serotonin) receptors to stimulate GI peristalsis and treat GERD. Newer agent often used in conjunction with other medications.

Question 12

Best treatment for barrett esophagus.

Answer 12

Long term PPI therapy

Question 13

When is surgery to treat GERD less effective?

Answer 13

In patients with atypical symptoms.
typical symptoms are: 
1. heartburn
2. acid regurgitation
(....so any symptoms other than these)

Question 14

What is Nissen Fundoplication?

Answer 14

Surgical treatment of GERD and hiatal hernia. The fundus of the stomach is wrapped completely around the distal esophagus to reinforce closing of the LES.

The toupet procedure is the same thing but the fundus is only wrapped around 270 degrees.

Question 15

Main target for treating Laryngopharyngeal Reflux disease (LRD).

Answer 15

Pepsin. It’s activated at pH~6.5 and will degrade structural proteins in the throat. Goal is to raise pH in the larynx and pharynx to ~8 to inactivate it and to stimulate salivation to wash it out. (can use lemon juice).

Question 16

GERD and acid reflux may not be the cause of LRD and pH treatments may not work. Other things can cause the same symptoms of LRD, name 4.

Answer 16

1. Post nasal drip
2. chronic cough and throat clearing
3. laryngeal irritation
4. speech changes