OnlineMedEd: Gastroenterology - "GERD"

Question 1

What things classically worsen GERD? What things improve it?

Answer 1

• Worsen: lying down (recumbency); spicy foods

* Improve: sitting up; antacids

Question 2

What are the rarer, atypical symptoms of GERD?

Answer 2

• Hoarseness

* Coughing

Question 3

What lifestyle modifications can stop the LES from relaxing aberrantly?

Answer 3

• Avoid eating peppermint, chocolate, alcohol, and smoking
• Raise the head of the bed
• Don’t have a large meal before going to sleep

Question 4

Once you have a history and exam that lead to GERD, what should you do?

Answer 4

• Have the person take a PPI and do lifestyle modifications for 6 weeks and follow-up.
• If they did not improve, then do endoscopy with biopsy.

Question 5

When might you do an EGD with biopsy in a person with GERD?

Answer 5

• If they have alarm symptoms at presentation (e.g., weight loss, night sweats, fevers)
• If they have GERD refractory to PPI therapy

Question 6

What should you do if they person has metaplasia, dysplasia, or adenocarcinoma on esophageal biopsy?

Answer 6

• Metaplasia: increase PPI therapy; f/u EGD with biopsy
• Dysplasia: local ablation; f/u EGD with biopsy
• Adenocarcinoma: resect and stage

Question 7

Pathologically, what is Barrett’s?

Answer 7

Metaplasia from esophageal squamous cells to intestinal columnar cells

Question 8

What is a Nissen fundoplication and when might it be used?

Answer 8

• It is a treatment for refractory GERD in which the top of the stomach is wrapped around the lower esophagus and tied off.
• It is typically used when PPIs don’t work (or when the patient can’t tolerate PPIs).
• Achalasia is a potential outcome.