GI-Misc. Gastric Disorders

Question 1

GERD

Answer 1

Path: Acid burns esophagus

• LES weakened
• Esophagitis

Pt: Typical:
- Burning CP
- Worse w recumbency, spicy food
- Better w antiacid, sitting up
Atypical:
- Hoarseness, coughing, stridor
- Nocturnal Asthma 

Dx: PPI + lifestyle x 6 wks

• EGD w Bx (start here w alarm sxs)
• 24 hr pH monitoring

Tx: GERD: PPI
Metaplasia: increase PPI
Dysplasia: local ablation
Adenocarcinoma: Resection

F/u: surveillance EGDs
- Nissen…more lifestyle than treatment

Question 2

Gastroparesis

Answer 2

Path: emptying the problem
- idiopathic/diabetes

Pt: Chronic N/V

• Abd pain w eating
• Peripheral neuropathy

Dx: EGD = r/o other disease
Nuclear emptying study
> 60% at 2 hrs
> 10% at 4 hrs

Tx: Avoid opiates

• Blood glucose control
• Prokinetic Agents (metoclopramide, erythromycin, domperidone)
• Low-Fiber, Small volume diet

Question 3

Cyclic Vomiting Syndrome

Answer 3

Path: + THC

Pt: habitual marijuana
- N/V in cycles (weeks)

Dx: Clx (right arrow) EGD (right arrow) Emptying

Tx: Stop THC

Question 4

Gastric Adenocarcinoma

Answer 4

Path: East Asian Cuisine
- Nitrites

Pt: Early satiety, weight loss, obstruction

Dx: EGD w biopsy = Signet
- PET/CT with/without Pan CT

Tx: Resection and chemo