Upper GI Flashcards
Esophageal Motility Disorders
Calcium channel blockers inhibit cellular uptake of calcium, thereby impeding contraction and promoting relaxation
Which diagnostic tests is recommended in the patient with GERD refractory to maximum PPI therapy?
24 hour pH monitoring
GERD Diagnosis
- An empiric trial of acid suppression therapy for 4-8 weeks can identify patients with GERD who do not have alarm symptoms
- Alarm symptoms – Black or bloody stools – Choking – Chronic cough – Dysphagia – Early satiety – Hematemesis – Hoarseness – Iron deficiency anemia – Odynophagia – Weight loss
• Obtain upper endoscopy in patients with alarm symptoms or those at high risk for complications
Summary of Diagnostic Testing for GERD
Potential Risks Associated with PPIs
Risk factors for esophageal intestinal metaplasia (Barrett’s Esophagus) include which characteristics?
Hiatal hernia
Risk Factors for Barrett’s Esophagus
Risk of intestinal metaplasia (Barrett’s) and adenocarcinoma increases with GERD symptom severity, duration, and frequency.
- Men – Screening women for Barrett’s is like screening men for breast cancer.
- Caucasian
- Age > 50 years
- Hiatal hernia
- Increasing BMI
- Abdominal fat distribution (abdominal obesity)
ACG Guidelines for Surveillance of Barrett’s Esophagus
Testing for Helicobacter pylori in patients with GERD
is NOT recommended
Esophageal Tumors
A 49 yo female presents with a 4-week history of epigastric pain. She reports the pain gets a bit better when she eats but worse within an hour of eating. She has been using an over-the-counter liquid antacid that she reports decreases her symptoms. She denies weight loss, hematemesis, melena, or hematochezia. With the exception of midepigastric tenderness, her exam is unremarkable. Her only medication is periodic acetaminophen, which she uses for headaches. Which of the following diagnostic tests would you recommend in your evaluation?
A. Serum gastrin
B. Helicobacter pylori serology
C. Esophagogastroduodenoscopy
D. Urea Breath Test
D. Urea Breath Test
Peptic Ulcer Disease Diagnosis
Diagnostic Tests for Helicobacter pylori
Treatment Regimens for H. pylori Infection
The standard treatment for an H. pylori infection is a triple therapy of two antibiotics and a proton pump inhibitor (PPI)
• Triple or quadruple therapy most effective
An Approach to Dyspepsia
Gastric Dysmotility
Slow or Delayed Emptying
Gastric Dysmotility Rapid Gastric Emptying
