GERD Flashcards
define GERD
the regurgitation or back flow of gastric contents (acid) into the esophagus
RF for GERD
- obesity
- hiatal hernia ➔ because hole in the diaphragm is too large allowing for the stomach to go through it
- postprandial supination
- increased age
- lower SES
- smoking, alcohol, drugs (NSAIDs, benzos etc.)
- pregnancy
- connective tissue disorders
pathphys of GERD
excessive or prolonged relaxation of the lower esophageal sphincter ➔ increased abdo pressure or position change ➔ backflow of gastric contents (acid) into the esophagus
can result in 1) esophageal erosion resulting in hematemesis and esophageal ulcers, 2) Barrett’s esophagus (precancerous), 3) esophageal strictures/narrowing
cx of GERD
esophageal ulcers, Barrett’s esophagus ➔ increased risk of developing esophageal cancer, esophageal stricture
s/s of GERD
heartburn ➔ retrosternal pain/burning that may radiate to the neck after meals and with a change in position
hematemesis
belching
epigastric pain
dysphagia and odynophagia (difficulty and pain with swallowing)
uncommon: cough at night (from acid regurg into the lungs), hoarseness, asthma, dental erosions, globus sensation (feeling of having a pill or something stuck in your throat)
Ix for GERD
no gold standard test
do other investigations to rule out ddx
- EGD for ddx of PUD or Crohn’s
- barium swallow test
- cxr or u/s
Diagnosis is made based on response to treatment ➔ can trial PPI, if improve with PPI then can consider dx of GERD
Tx for GERD
- Pt education for lifestyle modifications (healthy eating, smoking cessation, alcohol reduction)
- PPI
- consider calcium supplements with LT use of PPI
- depending on etiology consider surgery
- obesity ➔ gastric bypass
- medication resistant ➔ nissen fundoplication
Epi for GERD
most commonly diagnosed gastrointestinal disease
more common in females
risk increases with age
