Cardinal signs of potential GERD
Dysphagia
Bleeding
Weight loss
Predominant etiology in GERD px’s
Inappropriate relaxation of the LES
Other reasons for GERD to happen
Hiatal hernia
Decreased LES pressure
Delayed Gastric emptying
Gastric factors that might contribute to GERD
- increased gastric volume after meals
-increased gastric pressure (due to obesity)
-Recumbency after meals
-Gastroparesis (delayed gastric emptying)
Drugs that decrease LES pressure (contributing to GERD development)
-Anticholinergics
-Ca channel blockers
-Tricyclic antidepressants
-Diazepam
-Progesterone
-Estrogens
How may GERD function as an asthma trigger?
Via micro aspirations of gastric acid w/airways irritation
Key symptoms of GERD
Heartburn (pyrosis)
Dysphagia
Regurgitation
In laryngopharyngeal reflux, gastric contents might reach the upper tract (ears, nose, throat) provoking symptoms such as:
-Hoarseness
-Chronic cough
-Sore throat
-Globus sensation
How can GERD be diagnosed?
Commonly, checking px history & by the response to medical therapy (PPIs)
What is a common, non-metaplasic, complication of GERD
Esophageal/Schatzki rings
How long are PPIs indicated for px’s w/GERD
8 weeks
Despites radiologic studies can only identify milder forms of GERD; for what other things they might be useful?
Detecting:
-moderate to severe esophagitis
-strictures
-Hiatal hernias
-Tumors
Which is the most common imaging study for GERD?
Barium Swallow
What does the L.A classification quantifies?
Length and circumference of mucosa break in esophagitis
What does Baclofen do?
Increase basal LES tone by inhibiting its relaxation
True or False. PPIs are indicated after meals
False. They are more effective taken 15-30 min before meals
Into what condition might GERD progress in case of untreated
Barret´s esophagus, that might even progress to esophageal adenocarcinoma
True or false. Women are more likely to develop esophageal carcinoma
False, men have higher risk to develop this kind of carcinoma
Primary clinical indication for esophageal manometry in px w/suspected GERD
For ruling out motility disorders, like achalasia, before surgery
Characteristic histological findings at Barret’s esophagus
Squamous epithelium being replaced for columnar epithelium & goblet cells
Standard care in px with NERD with normal-appearing esophagus despites still heartburn
PPI due to symptoms
Which is the most widely performed surgical procedure for this disorder
Nissen fundoplication involves wrapping of the fundus around the bottom of the esophagus to
enhance the antireflux barrier.
