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GERD
Gabriel-GERD
Question | Answer |
---|---|
CREST syndrome | characterized by calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia rheumatologic disease: tight leathery skin; smooth muscle around GI tract becomes fibrotic |
esophageal scleroderma | autoimmune disorder primary defect: smooth muscle atrophy and fibrosis due to severe GERD secondary to distended LES and hypomotile esophagus smooth muscle replaced by scar tissue-->loss of peristalsis and a weakening of LES |
hiatal hernia | an etiology of GERD removes augmentation of crural diaphragm on LES-->results in lower threshold for TLESRs to occur |
gastric factors that can cause GERD | delayed gastric emptying: gastroparesis, gastric outlet obstruction overproduction of acid (rare): Zollinger-Ellison syndrome abdominal straining low gastric volume: gastric stapling/bariatric surgery |
Zollinger-Ellison syndrome | triad: 1) gastric acid hypersecretion 2) sever peptic ulceration 3) non-beta cell islet tumor of pancreas common cause is gastrinoma of duodenum or pancreas |
intrinsic mucosal factors that prevent GERD | stratified squamous epithelium intercellular tight junctions growth factors: maintain integrity of epithelium production of mucin, bicarbonate, epidermal growth factors *when these factors are overwhelmed: GERD causes reflux esophagitis |
esophageal symptoms of GERD | common: heartburn, acid regurgitation less common: waterbrash (hypersalivation), dysphagia, odynophagia, chest pain |
heartburn | retrosternal burning sensation |
acid regurgitation | sour/bitter return of gastric contents |
typical symptoms of GERD | heartburn and acid regurgitation-->justifies medical therapy |
esophageal chest pain | GERD most common cause of non-cardiac chest pain occurs at any part of chest and radiates to neck, arm, or back ALWAYS RULE OUT CARDIAC CAUSES |
airway symptoms of GERD/LPR-laryngopharyngeal reflux | cough, wheezing, sore throat, repetitive throat clearing, post-nasal drip, neck or throat pain, globus sensation, apnea, otalgia |
Barrett's esophagus | change in esophageal epithelium: no inflammation, just change in cell type (squamous-->columnar) prevalence increases with duration of reflux symptoms-->can lead to adenocarcinoma |
endoscopy | direct visualization of esophageal mucosa-->always done if alarm symptoms are present linear erosions seen in esophagitis biopsies can be taken |
alarm symptoms | bleeding, dysphagia, odynophagia, weight loss, anemia |
barium swallow | used to ID strictures and hiatal hernias insensitive for detection of erosions low-yield procedure for evaluation of GERD symptoms |
ambulatory esophageal pH studies | pH probe placed in esophagus for 24-48hrs-->patient keeps diary-->look for correlation between symptoms and pH<4 indicates atypical symptoms, ENT symptoms, frequent atypical chest pain, refractory symptoms, pre-op confirmation of GERD |
gastroesophageal scintigraphy | rarely used: Rarely used, feed patient technetium 99m sulfur meal-->obtain post-prandial images-->aspiration can be detected |
Bernstein test | rarely used: infuse HCl via NG (naso-esophageal) tube and look for symptoms-->water and acid alternatively infused-->water will relieve symptoms |
treatment of GERD | lifestyle modication, acid neutralization, chewing gum, PPIs (omeprazole, lansoprazole), prokinetics (metoclopramide), H2-blockers (cimetidine, ranitidine), surgery/endoscopic therapy |
fundoplication | surgical GERD treatment: wrap fundus of stomach around lower esophagus to tighten LES |
proton pump inhibitors | inhibit basal and stimulated acid production of parietal cell pronounced and long-lasting; most potent inhibitors of acid secretion ex) omeprazole, lansoprazole |
metoclopramide | treatment for GERD-->a prokinetic: promotes gastric emptying |