GERD

Question 1

symptoms and aggravating factors for GERD

Answer 1

-retrosternal chest pain (heartburn)
regurgitation
water brash (excessive saliva from acid)
hoarsness, dry cough, aspiration pneumonia

aggravating: lying down after meals, certain foods and drinks (coffee, alcohol, spicy food)

Question 2

risk factors for GERD

Answer 2

sliding hiatal hernia
smoking, caffeine, alcohol
obesity, pregnancy
angle of his enlargement
GI tumors
scleroderma

Question 3

red flags in GERD

Answer 3

dysphagia, odynophagia
unintentional weight loss
anemia or upper GI bleeding
vomiting

Question 4

diagnosis and approach to GERD

Answer 4

1. trial of PPI for 8 weeks until symptoms are relieved, this confirms GERD, then discontinue meds
2. if symptoms persist/ recur after discontinuation/ red flags present = do endoscopy
3. further diagnostic studies: esophagus ph monitoring, manometry, barium swallow (rule out esophagus motility disorders, sliding hiatal hernia)

Question 5

treatment plan for GERD?

Answer 5

-PPI for 8 weeks, if good response with no complications, discontinue. patrial response: increase dose, no response -> endoscopy

alternatives: H2 antagonists, antacids

lifestyle modifications: elevate head of the bed, avoid sleeping 2 hrs after meals, avoid caffeine and alcohol, eat small portions, avoid triggering foods

Question 6

surgical indications for GERD?

Answer 6

indications: failure of medical therapy, complications despite medical therapy (aspiration pneumonia), strictures, esophagitis

surgery: nissen fundoplication

Question 7

barret esophagus define, symptoms, diagnosis, treatment?

Answer 7

distal esophagus changes from squamous epithelium into columnar epithelium with goblet cells.

symptoms like GERD plus hematemesis

diagnosis by endoscopy with biopsy
treatment: PPI use with endoscopic surveillance every 3-5 years (1% risk off becoming malignant per year)

Question 8

risk factors for esophageal adenocarcinoma vs SCC WITH locations? symptoms?

Answer 8

adenocarcinoma: male, old age, smoking, GERD, barrett, location in distal esophagus

SCC: male, old age, smoking, alcohol, diet low in fruit and vegetables, radiation, achalasia. location in upper 2/3

symptoms: ASYMPTOMATIC, progressive dysphagia and odynophagia, weight loss, upper gi bleed, cervical adenopathy,

Question 9

diagnosis and treatment of esophageal cancer?

Answer 9

-barium swallow: apple core (stenosis with proximal dilation)
-endoscopy with biopsy
-CT abdomen

treatment: surgical resection or palliative with stent dilation