GERD ☺️

Question 1

Description

Answer 1

Stomach acid flows back into esophagus and mouth which causes irritation
Reflux causes frequent symptoms or damages esophageal tissue

Question 2

Epidemiology

Answer 2

Increases with age, slightly higher in women overall

Question 3

Aetiology

Answer 3

Food triggers - fatty, spicy 
Obesity
Pregnancy
Smoking
Stress 
NSAIDs
Hiatus hernia

FHx

Question 4

Pathology

Answer 4

Increased abdominal pressure and weaker LES increases the likelihood of the stomach contents to be pushed up into the esophagus
The esophagus does not have a protective mucus layer so it becomes inflammed => spasms cause retrosternal pain
If upper esophageal sphincter is relaxed, acid can rise up into the pharynx, larynx, mouth => hoarse voice, cough

Question 5

Symptoms

Answer 5

Heartburn after eating, lying relieved by antacids
Regurgitation, burping, acid taste in mouth
Epigastric, chest pain
Painful swallow due to inflammed esophagus
Hoarse voice
Enamel erosion

May be taking NSAIDs
History of hiatus hernia
FHx of heartburn, GERD

Question 6

Differential diagnoses

Answer 6

Vascular => WANT TO RULE THESE OUT FIRST

• ACS => chest pain that radiates to jaw, neck, arm
• Stable angina => chest pain that is worse on exertion, relieved by rest and GTN

Infective/inflammatory

• peptic ulcers => HPylori test
• esophagitis, gastritis => haematemesis
• esophageal stricture decondary to esophagitis

Neoplastic
-esophageal, gastric malignancy => appetite and weight loss, haematemesis, dysphagia, anemia

Question 7

Signs

Answer 7

Physical exam is generally normal

• obese
• increased age

ALARM SYMPTOMS AND SIGNS => RULE OUT ESOPHAGITIS, PEPTIC STRICTURE, CANCER

• anemia
• dysphagia
• haematemesis, melena, persistent vomiting
• unexpected weight loss

Question 8

Investigations

Answer 8

CLINICAL DIAGNOSIS

PPI trial for 8wks => further tests needed if symptoms do not improve or has alarm symptoms

May consider a OGD
-alarm symptoms or complicated disease => may find cause

Question 9

Management

Answer 9

Lifestyle - MAIN APPROACH

• weight loss, smoking cessation, reduce alcohol
• avoid trigger foods
• smaller meals, don’t eat immediately before bed
• sleep with bed head raised or sleep on left
• stress, anxiety management

Medication review
-reduce or stop exacerbating drugs

Pharmacological
-PPI

Advise for follow up if refractory or recurrent symtpoms

Question 10

Prognosis

Answer 10

If untreated, annual recurrence risk is 50% and the lifetime risk is 80%
-1 year relapse likely unless maintenance therapy given

Relapse more likely if
-severe esophagitis

10-15% will develop Barrett’s esophagus => 1-10% will develop adenocarcinoma