GERD Flashcards
Common, relapsing condition of the upper GI characterized by excessive reflux of gastric contents that leads to symptoms and tissue damage
GERD
____% of Americans will suffer from GERD at some time
60
Prevalence of GERD increases after the age of ____
40
(Men or Women) are more likely to develop chronic issues/complications related to GERD
Men
Frequency of GERD is (low / high)
Low due to the use of OTC meds
What can cause increased intra-abdominal pressure that can lead to GERD? (6)
- Full stomach
- Obesity
- Poor posture, lying down, bending forward
- Heavy lifting
- Persistant coughing
- Pregnancy
What can cause excessive relaxation of the lower esophogeal sphincter muscle which can lead to GERD? (3)
- Pregnancy - due to high levels of progesterone
- Smooth muscle relaxants
- Nicotine, alcohol, caffeine, chocolate, peppermint, foods that are fatty, fried, garlic, or onion
What factor can cause gastric hyperacidity?
Zollinger-Ellison syndrome which is a genetic disease that causes an increase in gastric secretion
Other factors that can cause GERD (2)
- Gastroparesis or obstruction which causes delayed gastric emptying
- Anticholinergic medications which decrease salivary bicarbonate that buffers gastric acid
What are normal esophageal defenses to protect from GERD? (4)
- High pressure of LES (10-30mmHG)
- Esophageal peristalsis
- Stomach emptying
- Salivary bicarbonate
What are changes in the normal defenses that can lead to GERD? (4)
- Sphincter pressure <10mmHG
- Impaired peristalsis - due to delayed gastric emptying and increased intra-abdominal pressure
- Decreased salivary bicarbonate production - due to anticholinergic medications
- Delayed gastric emptying
What are the pathologies of GERD that relate to increased exposure of the esophagus to stomach acid? (4) (i.e. what happens to the esophagus when it is exposed to acid)
- Irritation and inflammation of esophagus
- Dilation of small blood vessels, increased vascular permeability, edema, tissue erosion (considered superficial), or even ulcerations (deep damage that penetrates the muscle layer)
- Scarring, strictures (closing or narrowing), and difficulty swallowing
- Esophageal metaplasia (Barrett’s esophagus)
What is Barrett’s esophagus?
Certain cell type of the esophagus is damaged and differentiates into a cell type that it is not supposed to be (similar to that of small intestine)
Excessive reflux of gastric contents into the esophagus causes symptoms associated with _________ ______ and ________
Esophageal injury and esophagitis
What are two components of acid reflux?
- Heartburn
2. Regurgitation
How many times a week must a patient report symptoms of acid reflux?
At least 2 times a week
What are atypical symptoms of gastric reflux? (4)
Hoarseness
Sore throat
Chronic cough
Wheezing
What are three other factors than the report of acid reflux that are commonly presented with GERD?
- Relief from empirical therapy such as a PPI
- Postprandial bloating in gastroparesis
- Dysphagia in advanced disease
Physical and labs are often _____ in a patient with GERD
Normal
What are four signs of a patient that needs additional testing?
- Dysphagia
- Bleeding
- Iron deficiency anemia
- Don’t respond to PPIs
What two GERD diagnostic tests?
Upper endoscopy
Ambulatory 24h pH
When is an upper endoscopy used, and what does it look for?
Used when symptoms of GERD extend for 5 years or more, or if a patient is on chronic maintenance with medication.
The endoscopy looks at the type and extent of tissue damage
When is an ambulatory 24h ph monitoring used in patients?
Indicated before surgery, for those not responding to PPIs, or patients displaying atypical symptoms
Grade I esophagitis is indicated by
Erythema (red/inflamed)
Grade II esophagitis is indicated by
Linear non-confluent erosions
Grade III esophagitis is indicated by
Circular confluent erosions
Grade IV esophagitis is indicated by
Stricture or Barrett’s esophagus
What is a barium swallow used for?
To look at stricture location and gastric emptying
What is manometry used for?
To monitor LES pressure, peristalsis, and pH
What are the three main complications of GERD?
- Esophagitis
- Stricture
- Barrett’s esophagus
Prevalence of esophagitis?
50%
Prevalence of stricture?
10%
Prevalence of Barrett’s esophagus, as well as the increase risk of developing cancer
10% in patients with chronic disease, with a 40x increase in risk of cancer
Relapsing after ceasing treatment for GERD is ______ and indicates the need for _______ maintenance
Common; continuous
