GERD

Question 1

GI Referral

Answer 1

patient has unintentional weight loss, dysphagia for solids or liquids, odynophagia, unexplained anemia, or chronic tobacco and alcohol exposure

Question 2

GERD Referral

Answer 2

patient has unintentional weight loss, dysphagia for solids or liquids, odynophagia, unexplained anemia, or chronic tobacco and alcohol exposure.

Consider strongly for patients over 50-55

Question 3

GERD Presentation

Answer 3

heartburn (retrosternal pain) and regurgitation

Atypical symptoms include fullness, epigastric pain, dyspepsia, nausea, bloating, belching

Question 4

GERD Types

Answer 4

Erosive and Non-erosive

Severity of symptoms is not a reliable indicator

Question 5

Causes of GERD

Answer 5

Transient lower esophageal sphincter pressure or low pressure
Poor acid clearance
Defect in esophagogastric motility
Impaired mucosal resistance
Altered hiatal anatomy
Hypersensitivity to gastric acid

Question 6

GERD Presentation Timing

Answer 6

Usually occurs within one hour of eating, especially after a large fatty meal
Some foods like sugar, peppermint, chocolate, coffee, garlic, onions lower the LES pressure

Question 7

GERD Diagnosis

Answer 7

CBC, H. Pylori antigen test

Failed empirical trial of PPI - refer for endoscopy

Question 8

GERD Management

Answer 8

Lifestyle changes (especially diet)

PPI for 8 weeks, if symptoms relieved then taper PPI

If symptoms remain then refer, if older than 50 or warning signs present then refer

For non-erosive GERD, PPI for 8 weeks then Histamine2 Receptor Antagonist for maintenance

For erosive GERD, Maintenance PPI needed

Question 9

Barrett’s Esophagus

Answer 9

premalignan condition from chronic GERD (5+ years)

Patches of changed columnar epithelium