gastrointestinal reflux Flashcards
what is the montreal definition for GERD?
a condition which develops when the reflux of gastric content cause troublesome symptoms or complications
what are the typical symptoms of GERD?
heartburn
regurgitationn n
what are the atypical symptoms of GERD ?
-non-cardiac chest pains
-hoarsness and chronic cough
-asthma,pulmonary fibrosis
hiccups, dental erosion
what are the complications of GERD?
esophageal erosion and/or ulcers
strictures
barret’s oesophagus
oesophageal adenocarcinoma
what to do once a patient present with symptoms of reflux disease ?
prescribe PPI
after administration of PPI , if symptoms persist what is the next step in management ?
perform an endoscopy
Based on the results of the endoscopy what is the next step in management ?
if the endoscopy is normal then pH monitoring is required along with manometry
what is NERD ?
non erosive reflux disease also called endoscopy negative disease
what is a sign that can be used to confirm diagnosis of GERD?
show improvement of symptoms to PPI
what are the indications for performing n endoscopy ?
1- failure of PPI therapeutic trial
2- patients with alarming features at presentation
3- patients previously endoscoped known to have grade C or D GERD
4- patients older than 50 years with risk factors for barrett’s oesophagus or oesophageal adenocarcinoma
5- chronic patients who report unusual disappearance of HB
what are the different grades of reflux oesophagitis ?
grade A : one or more mucosal breaks no longer than 5 mm that doesn’t extend between the twoo mucosal folds
Grade B : one or more mucosal break, more than 5mm loong that does not extend between the tops of two mucosal breaks
Grade C : mucosal breaks less than 75 % of the circumference , breaks are continuous between the tops
Grade D: one or more mucosal break that involves more than 75% of the esophageal circumference
what is the most prevalent grade of esophagitis ?
grade B
what is the gold standard for the diagnosis of GERD?
ambulatory 24 hr pH studies
step down vs step up approach ?
step down is proven to be better where you start with PPI instead of antacids
do GERD patients need long life treatment ?
there must be a trial to stop PPI except in grade C and grade D
