GERD Flashcards
Probability GERD - Barrett - Adenocarcinoma
10% of GERD make Barrett
1% of Barrett make Adenocarcninoma (per year)
Reconversion Barrett to normal
94% of Fundoplicatio convert back to normal after 12 months
63% of PPI convert back to normal
High grade Dysplasia
Resection recommended
53% have carcinoma in situ in the resection piece.
Barrett
Nissen recommended
Extra esophageal symptoms
Anything other than esophagus
cough, wheezing, hoarseness, sore throat, postnasal drip, dental erosion, and ear pain
Red flags
HeDySaVoMeLo Hematemesis Dysphagia early Satiety Vomiting Melena weight Loss
may be sentinels of erosive esophagitis, strictures, or cancer
Symptom based specificity
60%
Los Angeles Classification of Esophagitis
Grade A One (or more) mucosal break no longer than 5 mm that does not extend between the tops of two mucosal folds
Grade B One (or more) mucosal break more than 5 mm long that does not extend between the tops of two mucosal folds
Grade C One (or more) mucosal break that is continuous between the tops of two or more mucosal folds but which involve less than 75% of the circumference
Grade D One (or more) mucosal break which involves at least 75% of the esophageal circumference
PH Metry
Post prandial PH below 4
Studies to rule out Motility disorder
Esophageal manometry: to rule out achalasia
HREM: a lot of senors, 3 dimensional cartographie
Gastric scintigraphy: technetium 99Tc sulfur colloid, images at 2h and 4h, useful pre op to exclude intra op lesion of vagal nerve injury.
Candidates for ARS (4)
GERD Complication
Osteoporosis
Lung transplant patient
Large hiatal hernia
GERD + Obesity
Roux Y and not Sleeve because if risk of progresion of GERD
Dor
Thal
Nissen
Toupet
180° anterior
Thal 90° anterior
360° posterior
270° posterior
