Reflux and Esophageal Disease Flashcards
(47 cards)
GERD definition
sx or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus
Heartburn 2/+ times a week
GERD is
a disease
Heartburn is
a sx
Esophagitis is
an endoscopic finding
What causes aggressive GERD?
Gastric acid
Pepsin
Bile acids
Pancreatic enzymes
What causes defensive GERD?
Impairment of lower esophageal sphincter pressure
What is the typical lower esophageal sphincter state?
contracted
Impairment of LES usually involves what?
Transient LES relaxation
Increased abdominal pressure
Atonic LES
What causes increased abdominal pressure
Straining
Bending
Coughing
Eating
What causes atonic LES?
Fatty foods
Gastric distention
Smoking
Medication
How do hiatal hernias affect LES?
The larger the hiatal hernia, the more frequently the patient’s LES will transiently relax allowing acid to flow back into the esophagus
What is the main determinant that causes damage and sx of GERD
Length of time acid spends in contact with the esophagus
GERD typical sx
Pyrosis (heartburn) Regurgitation Belching Dyspepsia Epigastric pain & nausea
GERD extraesophageal (atypical) sx
Cough Asthma Laryngitis Chest pain Dental erosions
GERD alarm sx
Dysphagia Odynophagia Unexplained weight loss Bleeding Anemia Chocking Continual pain despite standard therapy
Diagnosis of GERD
Clinical (most common)
Endoscopy
Ambulatory pH monitoring
Manometry
Complications of GERD
Esophagitis
Strictures
Barrett’s esophagus
Barrett’s esophagus
Precancerous condition
More frequent/severe sx = increased risk
Lower esophageal tissues begins to look like the stomach
Hx of heartburn and regurgitation
Endoscopy (every 3-5 years) and biopsy for diagnosis
GERD lifestyle interventions
Weight reduction
Raising head of the bed
Avoid eating 3 hs before bedtime
Avoid lying down for 3 hours postprandially
Avoid foods and medications that reduce LES pressure
Dietary restriction of fat
Drugs that lower LES
Anticholinergics Benzos DHP CCBs Estrogens, progesterone Theophylline Tetracycline Narcotics EtOH Smoking
Foods that lower LES
Caffeine Peppers Onions Garlic Chocolate Spearmint/peppermint Coffee, tea, soda Fatty meals, spicy food
Drugs that irritate the esophagus
Bisphosphonates ASA Fe NSAIDs K Cl
Foods that irritate the esophagus
Tomato juice
Citrus juice
Spicy foods
Coffee
Aluminum causes
Constipation
