E1: GERD

Question 1

What are the possible complications of GERD?

Answer 1

• Barretts esophagus
• Erosive esophagitis
• Strictures
• esophageal cancer

Question 2

What is it called when the lower esophageal sphincter is relaxed, allowing backflow of stomach contents?

Answer 2

GERD

Question 3

What are the extraesophageal manifestations of GERD?

Answer 3

• Bronchospasm/wheezing
• Larngitis
• chronic cough
• loss of dental enamel

Question 4

What medications decrease the LES pressure?

Answer 4

Anticholinergics, TCAs, CCBs, nitrates, and narcotics

Question 5

What drugs can injure the GI mucosa?

Answer 5

-Bisphosphonates, Iron supplements, NSAIDs, potassium, tetracycline

Question 6

What is the most common type of Hiatal hernia?

Answer 6

Sliding hernia

Question 7

What will you see on CXR of a patient with a hiatal hernia?

Answer 7

A retro cardiac mass with or without an air fluid level

Question 8

What is the best diagnostic study to evaluate mucosal injury?

Answer 8

EDG

Question 9

What is the treatment of GERD?

Answer 9

• Lifestyle: Elevate head of bed, weight loss, selective elimination of triggering food
• Medication: Tums, PPIs, H2 blockers
• Anti-reflux surgery

Question 10

What is the treatment of mild/intermittent GERD?

Answer 10

-Lifestyle modification, H2 blockers, and antacids

Question 11

What is the treatment of GERD with severe symptoms?

Answer 11

-PPI daily x 8 weeks and lifestyle modification

Question 12

How do H2 blockers treat GERD?

Answer 12

They block histamine at H2 receptors of gastric parietal cells, which leads to decreased secretion of stomach acid

Question 13

How do PPIs treat GERD?

Answer 13

They reduce the amount of acid being produced by glands in the stomach
-take 30 minutes before the first meal of the day

Question 14

What are the possible complications of long term PPI use?

Answer 14

• Risk of infection (acidic environment is protective)
• Malabsorption: Mg, B12, calcium, iron
• *Check Mg periodically

Question 15

How long should a patient with GERD be on medication if they do not have severe erosive esophagitis and Barrett’s esophagus?

Answer 15

-They should have the lowest dose and shortest duration appropriate and discharge meds completely in patients without symptoms

Question 16

How should patients with GERD and severe esophagitis or Barretts esophagitis be treated?

Answer 16

They require maintenance acid suppression with a PPI

Question 17

What are the indications for surgical management of GERD?

Answer 17

• Failed optimal medical management
• GERD complications (barretts)
• Noncompliance

Question 18

What is the most common cause of esophagitis?

Answer 18

GERD

Question 19

What is Barrett’s esophagus?

Answer 19

When squamous epithelium in the distal esophagus is replaced with columnar epithelium

Question 20

What is a patient with Barrett’s esophagus at increased risk for?

Answer 20

Adenocarcinoma

Question 21

What is the treatment of Barrett’s esophagus?

Answer 21

• Indefinite use of PPI
• EDG surveillance to detect evidence of dysplasia
• Endoscopic eradication therapy

Question 22

What are the two main types of esophageal cancer?

Answer 22

Adenocarcinoma and squamous cell carcinoma

Question 23

What are the risk factors for esophageal adenocarcinoma?

Answer 23

Barretts, smoking, and obesity

Question 24

What are the risk factors for esophageal squamous cells carcinoma?

Answer 24

Smoking, ETOH, diet low in fruits/vegetables, caustic esophageal injury, and nutritional deficiencies

Question 25

What test us recommended in all patients with dysphagia?

Answer 25

EGD

Question 26

If a patient has DM, asthma, and recent ABx use, what kind of esophagitis are they at increased risk for?

Answer 26

Infectious (candida)

Question 27

If a patient has asthma, rhinitis, food allergies, and chronic eczema, what kind of esophagitis are they at increased risk for?

Answer 27

Eosinophilic esophagitis

Question 28

What is it called when there is high pressure contractions in the esophagus and normal relaxation of the esophagogastric junction?

Answer 28

Hypercontractile (jackhammer) esophagus

Question 29

How is hypercontractile esophagus diagnosed?

Answer 29

DES manometry

Question 30

What is the treatment of Hypercontractile esophagus?

Answer 30

Control GERD and relax hypercontractile smooth muscle (PPI, CCB)

Question 31

If a patient has aperistalsis on manometry and birds beak on the barium esophagram, what should you be concerned about?

Answer 31

Achalasia

Question 32

What causes achalasia?

Answer 32

Progressive inflammation and degeneration of esophageal neurons

Question 33

What are the symptoms of achalasia?

Answer 33

Dysphagia, regurgitation, difficulty belching, CP, and heart burn

Question 34

How is achalasia diagnosed?

Answer 34

- Manometry is required - EGD necessary to r/o CA - Barium swallow: dilation of esophagus and birds beak

Question 35

What is the treatment of achalasia?

Answer 35

- Mechanical disruption of LES muscle fibers (pneumatic dilation and heller myotomy- incision into the muscles of the LES) - Biochemical reduction in LES pressure

Question 36

What is Mallory Weiss syndrome?

Answer 36

-mucosal laceration in distal esophagus and proximal stomach

Question 37

What are the predisposing factors of Mallory Weiss syndrome?

Answer 37

Heavy alcohol use and hiatal hernia

Question 38

What is the treatment of Mallory Weiss syndrome?

Answer 38

- Stabilize patient - PPI - endoscopic bleeding control if it doesn’t stop on its own - address other predisposing factors

Question 39

What medications can be used in achalasia to biochemically reduce the LES pressure?

Answer 39

Botulinum toxin, nitrates, and CCBs