GERD Flashcards
the majority of GERD patient’s symptoms are related to what? (2)
gastric over-filling
transient relaxation of LES
what 2 classic symptoms help establish the diagnosis of GERD?
heartburn
acid regurgitation
what are 3 possible physical findings in a patient with GERD?
inflammation/erythema of oropharynx
lung wheezing
laryngitis (hoarse voice)
what diagnostic creates presumptive diagnosis of GERD and eliminates further testing?
patient trial of GERD medication
what diagnostic has a specificity that is too wide to be “gold standard”?
ambulatory 24 hr esophageal pH monitoring
what is the gold standard for diagnosing and assessing esophageal COMPLICATIONS of GERD?
upper endoscopy
what are 3 treatment options for GERD?
dietary/lifestyle changes
famotidine (H2 blocker)
OR
omeprazole (PPI)
patients with good PPI response may D/C the med after _____ weeks
8-12 weeks
what treatment can be considered in otherwise health patients with severe symptoms, non-compliant patients with severe disease, or patients with a large hiatal hernia refractory to treatment?
surgical fundoplication
surgical fundoplication can lead to what? (3)
dysphagia
bloating
flatulence
what are red flags that warrant an immediate upper endoscopy + PPI meds?
symptom onset > 50 yo
dysphagia
odynophagia
weight loss
+ FOBT, melena, hematemesis, anemia
PPI failure
FHx of GI cancer in 1st degree relative
what are 4 complications of GERD?
erosive esophagitis
esophageal stricture
barrett esophagus
esophageal cancer
epithelialization with metaplastic columnar epithelial cells in the esophagus, containing goblet and columnar cells > 1cm proximal to the gastroesophageal junction
barrett esophagus
why do patients with barrett esophagus have improved symptoms?
decreased acid sensitivity of the new metaplastic columnar epithelium cells
what must diagnose barret esophagus?
upper endoscopy
