Esophageal Disorders

Question 1

Which conditions/risk factors increase esophageal perception of reflux episodes?

which conditions decrease esophageal perception of reflux episodes?

Answer 1

Increase:
affective disorders (anxiety, sleep deprivation, stressful states, hyper vigilance)

Decrease:
elderly (who can have reduced esophageal perception despite advanced erosive disease)
Barrett’s esophagus and DM are also associated w/ reduced esophageal perception

Question 2

which GERD symptoms respond best to PPI?

Answer 2

heartburn (NNT 2)

atypical chest pain is the atypical reflux sx most likely to respond to PPI

regurgitation does not respond well to acid suppression, and can persist despite adequate heartburn response

<20% of pts w/ chronic cough and hoarseness respond to PPI tx

globes response to PPI is even worse

LESSON:
the more atypical the sx, the higher the need for pH monitoring off PPI to rule in/out reflux disease, since positive pH testing can predict treatment response to PPI.

Question 3

dysphagia is a consequence of anti reflux surgery. classify the types of postoperative dysphagia

Answer 3

EARLY POSTOPERATIVE DYSPHAGIA:

• likely 2/2 postoperative edema
• usually improves w/o tx

LATE POSTOPERATIVE DYSPHAGIA:

• persisting beyond (or occurring) 3mo after surgery
• 6-25% of pts
• 2/2 wrap dysfunction, esophageal hypo motility, recurrent reflux, etc

Question 4

what are risk factors for poor outcomes for anti reflux surgery?

Answer 4

• preoperative dysphagia

- absence of contraction reserve on preoperative manometry

Question 5

True or False.

belching and regurgitation improve following anti reflux surgery

Answer 5

True.

recurrence of belching and regurgitation may be signs of wrap dysfunction

Question 6

what is rebound acid hypersecretion?

Answer 6

rebound acid hypersecretion is where you have acid hypersecretion after d/c of anti secretory therapy.

you may see this in pts who suddenly d/c their anti secretory therapy after successfully controlling their reflux. Instead, they should consider slowly downtitrating their PPI.

Question 7

what qualities of visible lesion of Barrett’s is least likely to be cured by endoscopic therapy?

Answer 7

A depressed lesion has the highest risk of submucosal invasion

irregular mucosal patterns and irregular vascular patterns are more consistent w/ neoplasia, too.

Question 8

define RFA failure.

what can you do as salvage therapy after RFA failure?

Answer 8

RFA failure - persistent Barrett’s segments even after 5 sessions of RFA

For RFA failure, you can use cryotherapy as salvage tx