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20 Cards in this Set
- Front
- Back
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What is the classic history of a patient presenting with GERD?
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Substernal chest pain associated with meals
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What is the drug of choice for GERD?
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PPI's, not H2 blockers
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When is surgical therapy considered over medical therapy?
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1) Patient not responsive to medical therapy
2) Cannot tolerate the medications 3) Prefers surgical intervention |
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Define gastroesophageal reflux disease.
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Symptoms of heartburn caused by acid regurgitation from the stomach into the distal esophagus
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Define Barrett esophagus.
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Squamous epithelium replaced with columnar epithelium in the distal esophagus; risk for esophageal adenocarcinoma
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What are the complications of GERD?
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Barrett esophagus, peptic strictures and extraesophageal complications
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What are the extraesophageal complications? What causes them?
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Thought to be caused by pharyngeal reflux and silent aspiration, leads to laryngitis, reactive airway disease, recurrent pneumonia and pulmonary fibrosis
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What physiological mechanisms contribute to GERD?
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Relaxation of the lower esophageal sphincter (LES), excess acid production by the stomach, delayed gastiric emptying
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What is a hiatal hernia?
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When the LES is abnormally located in the chest causing the antireflux mechanism to be compromised at the gastroesophageal junction
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What is the workup for patients with self-limiting or mild GERD?
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None, just treat with PPI's
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When do you start extensive workup for GERD?
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When the patient has
1) Long-standing or atypical symptoms 2) Recurrence of disease after cessation of medical therapy 3) Unrelieved symptoms when taking max-dose PPIs |
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What should surgeons order before performing a surgical antireflux procedure to evaluate a patient with GERD?
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1) Endoscopy - biopsy, malignancy
2) Manometry - competency of LES 3) Barium study - location of GE junction, hiatal hernia 4) 24-hour pH monitoring - symptoms with reflux |
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What is the initial treatment for patients with GERD?
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Lifestyle modifications and medications as needed
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What is the purpose of the PPI's?
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Acid suppression therapy
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What does lack of symptomatic relief with PPIs indicate?
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Possibility of an alternative diagnosis
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When is surgical therapy mainly indicated for patients with documented GERD?
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Patients have persistent symptoms when taking maximal doses of PPI
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What is the standard surgical procedure for antireflux operations?
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Nissen fundoplication, 360-wrap of the fundus of the stomach around the GE junction to act as a valve to prevent acid reflux
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What is the success rate of Nissen fundoplication?
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> 90%
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What is the most reliable clinical indicators of GERD?
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Response to a PPI
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What is the most reliable objective indicator of GERD?
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24-hour pH monitoring at the GE junction
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