Upper GI

Question 1

Gastroesophageal Reflux Disease (GERD)

Answer 1

-reflux of stomach content
causes troublesome symptoms and/or complications
-Chest pain, Cough
Throat clearing, Sore throat
Hoarseness, Globus
-Dx: Empiric trial of acid suppression, abnormal pH study, erosive esophagitis, Barrett’s esophagus, peptic stricture
-Upper endoscopy

Question 2

GERD management

Answer 2

-PPI: 30-60 min before meals (omeprazole (Prilosec, Prilosec OTC, Zegerid)
lansoprazole (Prevacid)
pantoprazole (Protonix)
rabeprazole (Aciphex)
esomeprazole (Nexium)
dexlansoprazole (Dexilant)
-Histamine 2 blockers (Famotidine (Pepcid AC, Pepcid Oral, Zantac 360)
Cimetidine (Tagamet, Tagamet HB)
Nizatidine Capsules)
-Surgery option
-HOB elevation
-Tobacco cessation
-Wt loss
-Avoid eating before laying down

Question 3

Barrett’s Esophagus

Answer 3

Esophageal squamous epithelial lining replaced by columnar epithelium extending ≥ 1cm above the gastroesophageal junction AND histological evidence of specialized IM

Question 4

Achalasia

Answer 4

Myenteric plexus degeneration resulting in aperistalsis and failure of the lower esophageal sphincter relaxation

Question 5

Scleroderma

Answer 5

-diseases that involve the hardening and tightening of the skin. It may also cause problems in the blood vessels, internal organs and digestive tract
-Rheumatology and GI consult
-LES-wide open and relaxed

Question 6

Mallory-Weiss Tear

Answer 6

-Long tears in the distal esophagus/proximal stomach. Found with forceful retching . Submucosal arteries bleed
-Hematemesis with epigastric or back pain
-Suspect with upper GI bleed and history of retching
-EGD

Question 7

Peptic Ulcer Disease (PUD)

Answer 7

-Causes: Helicobactor pylori: Duodenal ulcer>Gastric. NSAIDs: Gastric ulcer>Duodenal ulcer
-Dyspepsia-burning, hunger pain, epigastric, affected by food and antacids
-Dx: Endoscopy, upper GI barium less sensitive

Question 8

Hiatal Hernia

Answer 8

Herniation of abdominal contents through esophageal hiatus
-Most asymptomatic
GERD symptoms
Dysphagia
Early satiety
-Surgical repair for selected patients
GERD treatment

Question 9

Gastritis

Answer 9

-Inflammation with mucosal injury
-Diagnosed by EGD with biopsy

Question 10

Celiacs

Answer 10

-Immune disorder triggered by gliadin component of gluten
-Inflammatory state of small bowel