Flashcards in GERD Deck (27):
What are the clinical manifestations of GERD?
Heartburn, regurgitation, waterbrash, dysphagia, new onset asthma, chronic cough, bronchitis, dental erosions, laryngitis, hoarsness, polyps, laryngeal cancer.
What are the diagnostic tests for suspected GERD?
Endoscopy , UGI, 24 hour pH test, esophageal manometry, gastric emptying test, impedance monitoring
What percentage of patients with longstanding GERD have Barrett's esophagus?
Which test is the gold standard for diagnosis of GERD?
24 hour pH test
When should esophageal manometry be used in the diagnosis and evaluation of GERD?
In patients in whom surgery is being considered
When should a gastric emptying test be performed?
When there is a history of DM, nausea/vomiting and postprandial bloating.
A 36 year old male with signs and symptoms concerning for GERD has a normal EGD. What test should be performed next?
24 hr pH study.
Indications for antireflux laparoscopic surgery
Chronic GERD symptoms despite medical therapy, Chronic GERD and desire to be off medications; complications of GERD (Barrett's, esophagitis, stricture) not responding to therapy, paresophageal hernia with GERD, pediatrics with GERD-esophagitis,, and high volume reflux despite therapy.
How are the majority of patients with GERD treated?
Medically: with medications (PPIs) and with diet and lifestyle modifications
In what percent of patients do proton pump inhibitors heal esophagitis?
True or false: Histamine receptor blockers are more effective at medically treating GERD than proton pump inhibitors.
False. PPIs have been shown to be more effective.
What is the primary operation currently used to treat GERD?
laparoscopic Nissen fundoplication
During dissection and mobilization of the esophagus for lap nissen, what orientation of the stomach facilitates division of the gastrophrenic ligament?
Pulling gastric fundus inferiorly and to the right
What is the position of the posterior vagus nerve?
Adjacent and to the right of the esophagus.
What is the position of the anterior vagus nerve?
Anterior surface of the esophagus
What percentage of cases lap Nissen cases result in esophageal perforation?
What is the incidence of conversion to open procedure for laparoscopic Nissen fundoplication?
Compared to open procedure, what are the advantages of the laparoscopic antireflux surgery (LARS) ?
Reduction in postoperative pain, shorter hospital stays, reduction in overall recover time, and improved cosmesis.
Surgery improves typical GERD symptoms (heartburn, regurgitation, and dysphagia) in what percentage of patients?
What percentage of patients develop new onset dysphagia postoperatively?
Is new onset dysphagia (which develops after antireflux surgery) permanent?
No, usually this resolves within one year
Which complication of Nissen fundoplication is more common in the laparoscopic approach?
Migration of wrap through esophageal hiatus
What do current endoluminal therapies for GERD entail?
Application of radio frequency energy or mechanical suturing of the GEJ. These function to either mechanically thicken the LES or to restore the valvular mechanism of the LES.
How is radiofrequency energy used to treat GERD?
The Stretta system applies radiofrequency energy to deliver controlled cautery to the GE junction. It causes heat induced thickening of the GE junction musculature, and reduces compliance of the LES, and via reduction in number of transient LES relaxations.
What is endoluminal gastroplication?
Mechanically increasing LES pressure by plicating the area of the esophagus at the squamocolumnar junction.
What treatment is available for patients with refractory GERD symptoms after gastric bypass?
Endoluminal therapy for treatment of GERD.