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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
Created by: kphom001



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