gerd Flashcards
What is GERD?
A syndrome characterized by reflux of stomach acid into the lower esophagus.
What is the primary factor in GERD?
Incompetent lower esophageal sphincter (LES), allowing gastric contents to move from the stomach to the esophagus, especially when supine or with increased intra-abdominal pressure.
What are the risk factors for GERD?
Obesity, certain foods, NSAIDs, potassium supplements, smoking, hiatal hernia.
How is GERD diagnosed based on symptom frequency?
Persistent mild symptoms once a week or moderate to severe symptoms twice a week suggest GERD.
What is the most common symptom of GERD?
Heartburn (pyrosis) – a burning, tight sensation beneath the lower sternum that may spread to the throat or jaw.
What triggers heartburn in GERD?
Food or drugs that decrease LES pressure or directly irritate esophageal mucosa.
How can GERD-related chest pain mimic angina?
Described as burning, squeezing, radiating to the back, neck, jaw, or arms; more common in older adults and relieved by antacids.
What is dyspepsia?
Pain or discomfort centered in the upper abdomen.
How is regurgitation described in GERD?
A hot, bitter, or sour liquid rising into the throat or mouth.
What respiratory symptoms are associated with GERD?
Wheezing, coughing, dyspnea, which may wake a person at night and disturb sleep.
What otolaryngologic symptoms are associated with GERD?
Hoarseness, sore throat, globus sensation (lump in throat), hypersalivation, choking.
What are the key lifestyle modifications for GERD management?
Avoid triggers, elevate HOB 30 degrees (use pillows or 4-6 inch bed blocks), avoid lying down for 2-3 hours after eating, stop smoking, manage stress, limit alcohol use, increase physical activity.
What is the recommended nutrition therapy for GERD?
No specific diet, but avoid foods that decrease LES pressure (chocolate, peppermint, fatty foods, coffee, tea) and foods that irritate the esophagus (tomato-based products, OJ, cola, red wine, soda). Avoid late evening meals, nighttime snacking, and milk. Eat small, frequent meals and drink fluids between meals to prevent stomach distention. Chewing gum or candies can help mild symptoms by increasing saliva production. Weight reduction is recommended if overweight.
When is surgical therapy considered for GERD?
For patients with complications like esophagitis, medication intolerance, stricture, Barrett’s esophagus (BE), or persistent severe symptoms.
What is the goal of surgical therapy for GERD?
To reduce reflux by enhancing LES integrity.
What is Nissen and Toupet fundoplication?
A procedure where the fundus of the stomach is wrapped around the lower esophagus to reinforce and repair the defective LES barrier.
What is a common post-op symptom after fundoplication, and how should it be managed?
Mild dysphagia caused by edema, which should resolve within the first month. Patients should report persistent symptoms like heartburn or regurgitation.
What is the LINX Reflux Management System?
A ring of small, flexible magnets enclosed in titanium beads and connected by titanium wires that strengthen the LES to prevent reflux while at rest.
What is a major restriction for patients with the LINX system?
They cannot undergo MRI because the device contains metal.
What are the two types of endoscopic therapy for GERD?
Endoscopic mucosal resection (EMR) and radiofrequency ablation.
How does radiofrequency ablation help GERD patients?
Delivers heat energy through radiofrequencies to create lesions that thicken the LES.
What is a dual purpose of EMR?
It can be used for GERD treatment and as a diagnostic test to obtain biopsy samples for cancer evaluation.
What are the key diagnostic tests for GERD?
1) History and physical assessment Upper GI endoscopy with biopsy and cytologic analysis
Esophagram (barium swallow)
Motility (manometry) studies
pH monitoring (laboratory or 24 hr ambulatory)
Radionuclide studies
How do PPIs help in GERD management?
Decrease HCl acid secretion by inhibiting the proton pump responsible for H+ secretion, reducing esophageal and gastric mucosal irritation.
What is the function of H2 receptor blockers in GERD treatment?
Block histamine action on H2 receptors, decreasing HCl acid secretion, reducing conversion of pepsinogen to pepsin, and decreasing mucosal irritation.
How do antacids help in GERD?
Neutralize HCl acid; should be taken 1-3 hours after meals and at bedtime.
What additional medication classes can be used for GERD?
Cholinergic, cytoprotective, prokinetic, and prostaglandin (synthetic) agents.
