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Terms in this set (23)
Physiologic process of effortless movement of gastric contents into the esophagus. This process happens to all.
Pathological is when this process causes damage to the esophagus, oropharynx, larynx or respiratory tree.
Hiatal hernia is a condition that makes patient more susceptible to ____
Chest pain Dental erosions Asthma/Cough
Hoarse Sore throat Aspiration Laryngeal ulcerations Stridor
Atypical or Extra Esophageal symptoms of GERD?
Heartburn, Regurg, Water Brash(hypersalivation that can occur before vomitting)
Classical symptoms of GERD?
FOBT(Fecal Occult Blood Test) + Bleeding
What are "alarm signs" to look for with a person with GERD?
1 episode of heartburn per week with NO nocturnal symptoms.
What is an "acceptable" outcome of GERD treatment? What is considered "control"?
If it responds to a course of acid suppression (antacids, H2A or PPI )
How can you CLINICALLY dx GERD?
Endoscopy and biopsy: normal appearance but abnormal bx, friable mucosa, erosions, ulcers, strictures.
Barium swallow usually for dysphagia
Ambulatory 24 pH assessment usually for atypical or unresponsive
Manometrics to test for motility or LES pressure(most surgeons want this b4 they cotemplate surgery.)
What are dx test you can do for GERD?
Chronicity when symptoms for longer than 5 yrs
Atypical especially when combined with pH monitoring
When should you order an Endoscope for a pt with GERD?
Behavior changes Table 140-1
Histamine 2 Antagonists
Proton Pump Inhibitors
Refer to Table 140-2
Atypical symptoms usually take double dosing and take months to respond except for chest pain which takes 3 weeks
Treatment for GERD?
Feeling of something stuck in back of throat and nothing is there. This is a common complaint for a person with GERD.
What is GLOBUS?
Avoid caffeine, tobacco, alcohol, NSAIDS, ASA
No bedtime snacking
Smaller more frequent meals
Avoid mints, large meals, citrics, chocolate, fat
Elevate head of bed
Loose weight, avoid tight fitting garments
What behaviour changes can be made to help with GERD?
Peptic strictures are dilated via endoscopy
Failure to respond not a good indication for surgery
Surgery especially for LES hypotension
Maintenance is ½ dose every day or full dose every other day or pulse ( full dose for 8-12 weeks of use 2x/yr )
What are medical treatments for GERD?
What is this?Replacement of squamous epithelium with intestinal metaplasia in response to GERD
Complication of GERD
More resistant to acid, therefore no SXs
30x risk of adenocarcinoma compared to general population
55-65 yrs old
White >AA and latino
Who gets Barrett's Esophagus
What is this?Endoscopy reveals extension of yellow-orange mucosa above the esophago-gastric junction
2 types : long segment >= 3cm and short segment< 3 cm
Basal cell hyperplasia
Dilated intracellular spaces
With GERD, you may see these on a biopsy?
Long segment BE
Risk factors for Barrett's Esophagus?
Treat the GERD.
Behavior modification Acid suppression
Other treatments: Dysplasia surveillance
Metoclopramide(reglan-careful w/tardive dyskinesia)
Other motility agents
Sucralfate ( bile acid agents-don't work to well )
Surgery for resistant GERD: Fundoplication is a full wrap, Toupet is a partial wrap , NOTES ( Natural Orifice Transluminal Endoscopic Surgery )
Treatment for Barrett's Esophagus?
intensify treatment for GERD and increase frequency of surveillance
Esophageal dysplasia treament: low grade dysplasia
Surgery(treatment is resection with gastric pull up
) or Endoscopic treatment (submucosal resection, photochemical/laser or thermal ablation )
Esophageal dysplasia treament: high grade dysplasia
What can cause refractory( resisting control or authority ) GERD?
Proper dosing - time and amount
Increase emptying ( motility )
Treat H. pylori
Other drugs ( baclofen, tricyclics, trazadone )
Treatment of Refractory GERD
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