GERD Flashcards
Gastroesophageal reflux disease is commonly abbreviated.
GERD
GERD is defined as symptoms or complications resulting from the reflux of gastric contents into?
the esophagus or beyond, such as into the oral cavity, including the larynx, or even into the lungs.
GERD is further classified as the presence of symptoms without what?
erosions on endoscopic examination.
GERD without erosions on endoscopic examination is also referred to as ? abbreviated?
non-erosive disease
abbreviated NERD
GERD could also be symptoms when erosions are present, which would be called and abbreviated as?
erosive reflux disease
ERD
The two characteristic symptoms of GERD are?
retrosternal burning commonly known as heartburn and regurgitation
while ________ __________ is the most common outcome of tissue injury with GERD.
reflux esophagitis
chronic reflux not adequately treated, can be complicated by what four things?
bleeding
development of esophageal strictures
Barrett esophagus
esophageal ardeneaux carcinoma
Gastroesophageal reflux disease can damage mucosal tissue how?
abnormal regurgitation of gastric contents into the esophagus
the epithelial cells lining the esophagus are resistant to _____ from foods but are sensitive to ______
abrasion
acid
GERD is a multifactorial disease in which _____ and _____ factors play a pathogenic role.
anatomic and functional
the primary pathophysiology associated with GERD is defective?
LES pressure
LES stands for?
lower esophageal sphincter
Reduced pressure or increased relaxation of the LES may result from what three things?
spontaneous transient LES relaxations
Transient increases in intra abdominal pressure
Atonic LES
The LES or lower esophageal sphincter, is normally an _____ ____ ____ with an elevated resting pressure, thereby preventing gastric contents from regurgitating into the esophagus.
atonic contracted state
Transient decreases in sphincter pressure account for approximately ______ of all episodes of reflux.
50%
Conditions that decrease LES sphincter tone or increase abdominal pressure contribute to GERD include what three things?
alcohol and tobacco use
Delayed gastric emptying
Increased Gastric Volume
What is a hiatal hernia?
a distention of the stomach above the diaphragm
hiatal hernia increases the risk for?
GERD
The anatomic disturbance from a hiatal hernia reduces what?
LES pressure
however not all patients with a hiatal hernia have _________.
GERD
and not all patients with GERD have a hiatal hernia
normally if gastric contents are regurgitated, ______ of the esophagus propels the contents back into the stomach.
peristalsis
if peristaltic contractions are reduced, the rate of esophageal _________ decreases.
clearance
GERD often results from an increased contact of gastric reflux with the esophageal mucosa and not?
excessive acid production
GERD can be bothersome at night for many patients due to what two things?
decreased swallowing while asleep
prone position
Swallowing increases what, that aids in the clearance and buffering of ingested contents?
salivary flow
Reflux can be particularly bothersome in patients with decreases saliva, such as what two populations?
elderly
patients with dry mouth syndrome
esophageal clearance is impaired by what three things?
ineffective peristalsis
reduced salivary secretion
reduced secretion from esophageal submucosal glands
numerous mucus secreting cells are located in the mucosa of the _____________.
esophagus
The _____ rich mucus protects the esophagus by neutralizing gastric reflux.
bicarbonate
Repeated exposures of acid gastric contents damaged the mucosa and mucus secreting cells. This in turn limits the ?
protective mechanisms, further perpetuating damage to the mucosa
name three factors that are interrelated and if increased contribute to GERD?
gastric volume, gastric contents, and delayed emptying of the stomach
gastric volume is influenced by what four factors?
volume and contents of the ingested food
gastric secretions
rate of gastric emptying
duodenal reflux into the stomach
GERD is often reported immediately after? especially if?
consuming a meal
especially if its a large meal that has particular contents into it.
the composition of the refluxate is?
active pepsin
reluxate has what kind of pH?
very low pH
the esophagus pH is?
5-7
the pH of the stomach is?
2-5
the pH of the duodenum is?
6.8
Active pepsin which degrades _____.
proteins
Duodenum reflux from the small intestine can also occur which contains what two things?
bile duct and pancreatic juices
Duodenum reflux can severely damage?
the mucosal cells in the esophagus
GERD can lead to what complications of the esophagus?
reflux esophagitis
development of esophageal strictures
barrets esophagus
esophageal adenocarcinoma
reflux esophagitis can cause erosion of the epithelial lining due to prolong exposure to ?
reflux gastric contents
Esophageal strictures, generally involved the ______ portion of the esophagus, resulting in possible ______.
distal
dysphagia
dysphagia is also known as?
difficulty swallowing or even painful swelling
medications such as ____ and _____ often worsen complications of GERD
aspirin and NSAIDS
Patients who experience GERD for years can develop chronic ________.
chronic esophagitis
Over time the normal squamous epithelial lining of the esophagus is replaced by abnormal specialized ________ type epithelial cells, resulting in?
columnar
Barrett esophagus
what condition greatly increases the risk of developing esophageal adenocarcinoma?
barretts esophaus
The clinical manifestations of GERD can be classified as _______ and _______ syndromes.
esophageal and extra esophageal syndromes
esophageal syndromes are _____ based or _______ based.
symptom based
esophageal tissue injury based
list the typical symptoms of typical reflux syndrome associated with esophageal GERD syndromes
heartburn
regurgitation, belching
reflux chest pain
heartburn is described as retrosternal burning or warmth arising from the stomach and may radiate all the way up to the _____.
neck
Regurgitation often leaves a ____ taste in the mouth
bitter acid taste
Patients with GERD can present with what two types of symptoms which should be distinguished from other cuases?
chest pain or pulmonary symptoms
syndromes with esophageal injury may present with alarm symptoms which are?
dysphagia
odynophagia
weight loss
bleeding
alarm symptoms with syndromes with esophageal injury necessitate further? indicating what?
diagnostic evaluation and may indication complications of GERD
list the four tissue injury-based Esophageal GERD syndromes that can present with alarm symptoms?
esophagitis
strictures
Barrett’s esophagus
Esophageal adenocarcinoma
GERD that affects organs other than the esophagus indicates?
extra esophageal syndromes
Extra esophageal syndromes includes ____ symptoms.
atypical
list the atypical symptoms that can present with extra esophageal syndromes?
chronic cough laryngitis asthma wheezing Dyspepsia
The severity of GERD symptoms ____ correlate with the tissue injury.
does not always
a clinical diagnosis of GERD is generally based on what three things?
symptoms
risk factors
response to empiric trial of acid suppression therapy
empiric trial of acid suppression therapy is often started with a ?
proton pump indibitor
patients with typical symptoms of GERD usually _______ require further diagnostic test.
do not
A PPI trial can be beneficial due to?
its efficacy and cost effectiveness in patients where cardiac cause has been excluded.
what are common risk factors associated with GERD
family history obesity smoking alcohol consumption (especially high amounts) respiratory disease reflux chest pain syndrome certain medications some foods
there is a strong association between GERD and _______
obesity
what are indications that are associated with symptoms and complications of GERD
increased BMI
waist circumference
weight gain
what population does GERD frequently occur in
pregnancy at any trimester
during pregnancy, GERD severity can ______ during this time period but should resolve ____ post delivery
severity increase
typically resolves after deliver
In patients that GERD does not resolve 1 year post delivery, what factors should be considered
the amount of weight gain that occurred during the pregnancy
maternal age is ____ related to heartburn symptoms
inversely
what are the significant predictors of heart burn with pregnancy
increased gestational age, heartburn before pregnancy, and parity
what are the demographic risk factors for GERD
pregnancy
older age
decreased education level
what are examples of foods and medications that decrease LES pressure
- fatty/heavy meals
- peppermint/spearmint
- caffeine, chocolate, coffee, cola, tea
- garlic, onions, chili pepers
- anticholinergics, barbiturates, dopamine, nitrates, dihydropyridine, CCB, tetracycline, theophylline, estrogen, progesterone
what are foods and medications that act as direct irritants to esophageal mucosa
spicy food, coffee, orange juice, tomato juice, aspirin, NSAIDS, quinidine, potassium chloride, iron, oral bisphosphonates
what position increased the risk for GERD
recumbent position, bending over
what are examples of comorbid conditions that are risk factors for developing GERD
hiatial hernia obesity IBS asthma angina anxiety/depression
2013 guidelines for diagnosis and management of GERD they recommended consideration of of a diagnostic evaluation with what two things before a PPI in patients were cardiac causes of chest pain have not been excluded.
endoscopy and pH
Diagnostic evaluation is useful to assess treatment failure, investigate potential ___________, and prevent misdiagnosis.
complications
diagnostic test are indicated in what two types of patients?
do not respond to therapy and in patients who present with alarm symptoms
What is the primary diagnostic test to evaluate the esophageal mucosa in patients with suspected GERD?
upper endoscopy
Describe what happens with an upper GI endoscopy?
what you can see, what you can do?
illuminated flexible endoscope is inserted down the esophagus into the stomach and the duodenum, which allows the practitioner to visualize the intra luminal mucosa and obtain specimens for biopsies if necessary.
What can the provider find with an upper GI endoscopy?
erosive esophagitis
strictures
barretts esophagus
Upper GI endoscopy can identify ERD but may potentially miss identifying characteristics of ______.
NERD
upper endoscopy is not required in the presence of _______ alone
typical symptoms alone
Endoscopy is indicated for what three situations?
presence of Alarm symptoms to screen high risk patients
evaluate non-cardiac chest pain
patients unresponsive to a PPI
ambulatory reflux monitoring enables the detection for presence fo abnormal?
esophageal acid exposure
reflex frequency
symptoms associated with reflux episodes
Ambulatory esophageal reflux monitoring is indicated for?
before consideration of endoscopic or surgical therapy in patients with NERD
Evaluation patients refractory to the PPI therapy
Where diagnosis of GERD is in Question
what happens with ambulatory reflux monitoring?
a small probe is placed in the esophagus, just above the LES in order to monitor for 24 hour acid levels.
_____________ allows for detection of reflux episodes.
impotence.
PPI trial is indicated for?
typical GERD symptoms
no alarm symptoms
a negative PPI trial _________ GERD
does not rule out
Endoscopy is indicated for?
screening of high risk patients
chest pain
alarm symptoms
One should consider performing an endoscopy early for what populations?
those at risk for Barrett’s esophagus
non-cardiac chest pain
patients unresponsive to PPI
Ambulatory reflux monitoring is indicated for?
refractory GERD symptoms
GERD diagnosis in question
Preoperatively for Non-erosive disease
When performing an ambulatory reflux monitoring a provider should document?
abnormal acid exposure and/or reflux frequency
When performing an ambulatory reflux monitoring a provider should correlate symptoms with?
reflux
hiatal hernias can occur when the stomach slides into the _____ or when a pouch of the stomach is pinched above the _________.
thorax
diaphragm
in cases where GERD and a large hiatal hernia coexist, the hernia may slow what? and contribute to severe?
acid clearance
severe esophagitis
list a few causes of GERD? 10 total, see how many you can get!
decreased salivation impair esophageal clearance impaired tissue resistance hiatal hernia decreased LES resting tone Increased total LES resistance increased gastric acid/pepsin secretion delayed gastric emptying pyloric incompetence bile reflux
