GERD -Jenkins

Question 1

What is the Z line?

Answer 1

transition between columnar to squamous epithelium

squamocolumnar junction =gastroesophageal junction

Question 2

If you find that someone is a NERD on a scope, do you re-scope?

Answer 2

NO!

once a NERD, always a NERD

(EE can transition to barretts and adenocarcinoma)

Question 3

What esophageal findings are more common in men vs women?

Answer 3

Men:

• EE
• Barrett’s
• abnormal endoscopy

Women:

• NERD
• normal endoscopy

Question 4

What should you do for a pt with heartburn at night?

Answer 4

PPI at night, lifestyle changes (sleep with head elevated, weight loss)

then if continues, can do an EGD

if a NERD pt but still with pain, can do surgery (last)

Question 5

What percentage of Americans experience symptoms of GERD? What are the risk factors?

Answer 5

20-25%

(80% of pregnant women)

risks: smoking, EtOH, Caffeine, fatty foods, increasing age, and obesity

Question 6

What is intestinal metaplasia of columnar cells (and goblet cells) of the distal esophagus epithelium? Is this a risk for anything?

Answer 6

Barrett’s Esophagus

risk for esophageal adenocarcinoma

Question 7

What are risk factors for BE?

Answer 7

white male that is overweight with long-standing GERD

-more prevalent in pts exposed to gastric acid AND duodenal contents

Question 8

What is a tongue shape distribution of columnar metaplasia above the Z line? What is the next step?

Answer 8

Barrett’s

biopsy to make sure no dysplasia (every 2-3 years)

Question 9

Is there treatment for esophageal low grade dysplasia?

Answer 9

yes

Question 10

What is the goal in pharmacological treatment of GERD?

Answer 10

gastric pH > 4

–> prevent mucosal injury and promote healing of erosive esophagitis

Question 11

How is BE treated? BE with dysplasia?

Answer 11

reflux management=PPI and H2 antagonist

dysplasia=ablation (once reflux is controlled)–> in an acid-free env’t will normally repopulate with squamous epithelium

Question 12

What are the risks for high grade dysplasia or esophageal adenocarcinoma? How does this affect surveillance?

Answer 12

• presence of low grade dysplasia
• BE > 10 years
• Longer BE segments
• presence of esophagitis

-1+ risk can increase surveillance in BE