GERD

Question 1

_____ occurs when refluxed gastric acid and pepsin induce inflammation of the esophageal mucosa that leads to microscopic injury and macroscopic erosions and ulcers.

Answer 1

Esophagitis

Question 2

Three dominant mechanisms of esophagogastric junction incompetence are recognized:

Answer 2

(1) transient LES relaxations (a vagovagal reflex in which LES relaxation is elicited by gastric distention),

(2) LES hypotension, o

(3) anatomic distortion of the esophagogastric junction inclusive of hiatal hernia.

Question 3

____ account for ~90% of reflux in normal subjects or GERD patients without hiatal hernia,

Answer 3

Transient LES relaxations

Question 4

Factors tending to exacerbate reflux regardless of mechanism are ____

Answer 4

abdominal obesity, pregnancy, gastric hypersecretory states, delayed gastric emptying, disruption of esophageal peristalsis, and gluttony.

Question 5

Two causes of prolonged acid clearance are _____

Answer 5

impaired peristalsis and reduced salivation

Question 6

gastric acid hypersecretion is usually not a dominant factor in the development of esophagitis T/F

Answer 6

T

Question 7

_____ can induce atrophic gastritis and hypoacidity, reducing the risk of esophagitis.

Answer 7

Chronic Helicobacter pylori gastritis

Question 8

Extraesophageal syndromes with an established association to GERD include ____

Answer 8

chronic cough, laryngitis, asthma, and dental erosions

Question 9

_____ at the esophagogastric junction is the endoscopic hallmark of GERD but identified in only about one-third of patients with GERD.

Answer 9

Erosive esophagitis

Question 10

_____at the esophagogastric junction is the endoscopic hallmark of GERD but identified in only about one-third of patients with GERD.

Answer 10

Erosive esophagitis

Question 11

In terms of endoscopic appearance, the ulcerations seen in _____ are usually few and distal, whereas _____ are numerous, punctate, and diffuse.

Answer 11

peptic esophagitis

infectious ulcerations

Question 12

Esophageal ulcerations from pill esophagitis are usually singular and deep at points of luminal narrowing, especially near the carina, with sparing of the _____esophagus.

Answer 12

distal

Question 13

The most severe histologic consequence of GERD is _____ with the associated risk of esophageal adenocarcinoma, and the incidence of these lesions has increased, not decreased, in the era of potent acid suppression.

Answer 13

Barrett’s metaplasia

Question 14

Barrett’s metaplasia, recognized endoscopically by ____-colored mucosa extending proximally from the gastroesophageal junction (Fig. 323-9) or histopathologically by the finding of specialized ____ metaplasia, is associated with a significantly increased risk for development of ___ adenocarcinoma.

Answer 14

salmon

columnar

esophageal