GERD & PUD Flashcards
is reflux of gastric contents into the esophagus normal?
yes!
how is GERD defined as? do there need to be lesions in order to dx GERD? how do the majority of pts w/GERD present on endoscopy?
reflux leading to sxs, eso muscoal injury or both
there do not need to be lesions in order to dx GERD
majority of pts w/GERD show no abn on upper endoscopy
what 4 tests can you use to dx GERD?
EGD
esophageal manometry
24 hr pH testing
gastric emptying study
typical sxs of GERD?
heartburn
regurgitation
define functional heartburn
sxs of heartburn are present w/o evidence of reflux
9 GERD extraesophageal sxs
hoarseness cough asthma pharyngitis sinusitis pulmonary fibrosis tonsillar fibrosis recurrent otitis media sleep apnea
when can one experience transient lower esophageal sphincter relaxations and what can it lead to?
increase in intra-abdominal pressure can overpower a hypotensive LES and lead to reflux during TLESRs
it is more common to occur for reflux to occur in TLESRs which is triggered by gastric distension and serve to enable gas to vent from the stomach
how long do TLESRs last for?
for about 20 secs
last significantly longer than the typical primary peristaltic wave
what 7 situations can lead to reflux sxs?
visceral hypersensitivity delayed gastric emptying hiatal hernia decreased defenses impaired esophageal clearance bacterial overgrowth reduced LES pressure
what are the 3 types of heartburn/reflux?
acid reflux
“neutral” reflux
functional heartburn
how can PPIs lead to both GERD and DGER?
PPIs lead to weakly acidic reflux which leads to dilated intercellular spaces and persistent heartburn sxs
what 3 physical settings can lead to GERD, erosive esophagitis or NERD?
sustained esophageal contractions
esophageal visceral hypersenstivity
abnormal tissue resistance
what can GERD sxs be exacerbated by?
CRAP C: coffee, cigarettes, chocolate R: refined carbs, carbs in general, rxs A: acid foods, alcohol, allergic foods P: pop, peppermint, packing food in at bedtime, progesterone
what kind of drugs can lead to GERD?
antibiotics (tetracycline)
bisphospohates (alendronate, ibandronate, risedronate)
iron supplements
quinidine
pain relievers (ibuprofen, aspirin)
potassium supplements
anticholinergics
tricyclic antidepressants
calcium channel blockers and nitrates used for high blood pressure and heart dz
narcotics (codeine, those containing hydrocodone and acetaminophen)
progesterone
quinidine
sedatives or tranquilizers (benzodiazepines, diazepam, temazepam)
theophylline
what %age of adults with NERD do not have relief of sxs with anti-reflux medications?
over 40% do not respond to standard medical anti-reflux tx