GERD study guide Flashcards
______ girth can lead to reflux esophagitis, esophageal strictures, Barrett’s esophagus, and esophageal adenocarcinoma
Increased
Reflux esophagitis can cause erosion of the __________ lining due to prolonged exposure of what?
Epithelial lining
Prolonged exposure to reflux gastric contents
Esophageal strictures typically involve what portion of the esophagus?
Distal position
Esophageal strictures can cause what?
Dysphagia
Dysphagia is what?
Difficulty/painful swallowing
What two types of medications can make GERD worse?
Aspirin and NSAIDS
Prolonged GERD that develops into chronic esophagitis, overtime the normal ______ epithelial lining of esophagus is replaced by? This is called?
Squamous epithelial lining
Specialized columnar epithelial cells
Barretts esophagus
If a patient has Barrett’s esophagus, what are they at risk for developing?
Esophageal adenocarcinoma
GERD is broken down into two syndromes which are?
Esophageal GERD syndrome
Extra esophageal GERD syndrome
Esophageal GERD syndrome is brown down into what two classes?
Symptom-based (with or without tissue injury)
Tissue injury-based (with or without symptoms)
Symptom based esophageal GERD syndrome can be divided into what two classes of symptoms?
Typical or alarm symptoms
What are the typical symptoms for Esophageal GERD syndrome that is symptom based?
Heartburn
Regurgitation
Reflux chest pain
Hallmark is HRR
What are the alarm symptoms for esophageal GERD syndrome that is symptom based?
Dysphagia (difficult or discomfort when swallowing) Odynophagia (pain when swallowing) Weight Loss Bleeding BOD Weight remember
Gastric reflux often leaves what kind of taste in the mouth?
Bitter acid taste in the mouth
Name the four common tissue injury based esophageal GERD conditions?
Esophagitis
Strictures
Barrett’s esophagus
Esophageal Adenocarcinoma
If syndromes with esophageal injury present with alarm symptoms what should happen?
Further diagnostic evaluation
Alarm symptoms of GERD necessitate what?
Further evaluation for potential complications
GERD that affects organs other than the esophagus indicate what?
Extra esophageal phageal syndromes
Extra esophageal syndrome include _______ symptoms
Atypical
List the atypical symptoms of Extra-esophageal GERD syndrome (5 things)
Chronic Cough Laryngitis Asthma Wheezing Dyspepsia
The severity of GERD symptoms does not necessarily correlate with _________.
Tissue injury
What is the indication for a PPI trial?
Typical symptoms
No alarm symptoms
What does a negative PPI trial mean?
It does not rule out GERD
What is the indication for an Endoscopy?
Screening of high risk patients
Chest pain
Alarm symptom
When would you consider doing an endoscopy early?
Those at risk for Barrett’s esophagus
Non-cardiac chest pain
Patients unresponsive to PPI
What are risk factors for Barrett’s esophagus?
Men Caucasian men 55 years old Obesity (especially big belly) Smoking Genetics
When is an ambulatory reflux monitoring indicated?
Refractory GERD symptoms
GERD diagnosis in question
Preoperatively for non-erosive disease
What are recommendations to duo with an ambulatory reflux monitoring test?
Correlate symptoms with reflux
Document abnormal acid exposure and reflux frequency.
What are PPI trials beneficial (two reasons)?
Efficacy (high) and cost effective
PPI trials can be performed on patients with typical symptoms where ______ cause has been excluded.
Cardiac
Patients with typical symptoms and a positive PPI trial does not require what?
Further diagnostic testing
For patients where cardiac causes of chest pain have not been excluded what is recommended by the 2013 guidelines?
Evaluation with endoscopy and pH monitoring
Patients who do not respond to therapy and/or present with alarm symptoms what is recommended for diagnostic testing?
Endoscopy or ambulatory reflux monitoring
What is the primary diagnostic test to evaluate the esophageal mucosa in patients with suspected GERD?
Upper endoscopy
Describe an upper endoscopy?
A flexible endoscope is inserted down the esophagus into the stomach and the duodenum, allowing for visualization of intraluminal mucosa and obtaining biopsies
Name three conditions that can be findings of GERD with an endoscopy?
Erosive esophagitis
Strictures
Barretts esophagus
Even though the upper endoscopy can be used to identify ERD it may miss identifying characteristics of?
NERD, because pets have GERD without evidence of esophageal injury
Describe ambulatory reflux monitoring?
A small probe is placed in the esophagus, just above the LES in order to monitor for 24 hour acid levels
What are the four classes of risk factor for GERD?
Genetic
Demographic
Behavioral
Comorbid Conditions
Name the three demographic risk factors for GERD?
Pregnancy
Older age
Decreased educational level
What behavior risk factors for GERD are there?
Smoking
Alcohol consumptions
Foods (fatty/heavy meals; peppermint; caffeine; chocolate; coffee;cola; tea; garlic; onions; chili peppers)
what are the comorbid conditions that increase risk for GERD?
Hiatal hernia Obesity (big belly) IBS Asthma Angina Anxiety; depression
When can GERD occur during pregnancy?
May occur at any trimester
Severity of GERD can increase during pregnancy, but usually resolves when?
After delivery
For patients who were frequent, GERD persists one year post delivery risk factors include?
Pregnancy and the amount of weight gain that occurred during pregnancy
Significant predictors fo heart burn include what for pregnancy patients?
Increasing gestational age, heart burn prior to pregnancy, and parity (the number of times that she has given birth to a fetus with a gestational age of 24 weeks or more).
Maternal age is _________ correlated with heartburn symptoms.
Inversely
What is NERD?
Non-erosive reflux disease
What is ERD?
Erosive reflux disease
Name the primary patho process associated with GERD is due to ?
Defective LES (decreased)
LES is normally in a _______ state with an elevated resting pressure?
Tonic
Transient decrease in the LES take place in _______ of reflux patients.
HAlf
Name the four things that decrease LES or increased abdominal pressure?
Alcohol
Tobacco
Delayed gastric emptying
Increase in gastric volume
What is the major anatomic factor that is a pathophysiological reason for GERD
Hiatal hernia
Hiatal hernia may __________ acid clearnance?
Slow
Hiatal hernia _________LES pressure
Reduces
What are the three ways to impair esophageal clearance and cause GERD?
Ineffective peristalsis
Reduced salivary secretion
Reduced secretion from esophageal submucosal glands
When gastric contents are regurgitated, _______ of the esophagus propels contents back into the stomach.
Peristalsis
GERD results from increased contact of gastric reflux with the _______ mucosa and not from excessive ______ production
Esophageal
Acid
At night GERD can be problematic because of what two things?
Decreased swallowing and prone positioning
Swallowing increases what?
Salivary flow
Salivary flow aids in the clearance and _____ of ingested contents
Buffering
What two patients population have decreased salivary production
Elderly and dry mouth syndrome
Mucus secreting cells of the esophagus secrete _______ rich mucus which protects the esophagus how?
Bicarbonate
By neutralizing gastric reflux
Repeated exposure to gastric acid contents does what to the mucus secreting cells of the esophagus?
Decrease their protective mechanism, allowing more damage to occur to the mucosa
How can gastric volume cause GERD?
If gastric volume increases due to volume and contents of food ingested, increased gastric secretions, decreased gastric emptying, or duodenal reflux into the stomach
GERD often occurs immediately after?
Consuming a meal (especially large and fatty)
What is the composition of refluxate in the esophagus, stomach, and duodenum?
Esophagus 5-7
Stomach 2-5
Duodenum 6.8
Refluxate contributes to _______ since the pH is very ____ and contains ______ which degrades proteins
Gastric juice
Low
Active pepsin
