Epidemiology
This condition is present when reflux causes troublesome symptoms and/or complications.
What is GERD?
A burning retrosternal sensation after meals or when recumbent is this symptom.
What is heartburn?
In a patient with classic heartburn/regurgitation and no alarm features, this is the recommended first diagnostic-management step.
What is an empiric once-daily PPI trial, usually for 8 weeks?
This class is first-line medical therapy for typical GERD.
What are proton pump inhibitors (PPIs)?
This premalignant complication involves intestinal metaplasia of the distal esophagus
What is Barrett esophagus?
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What is Russia?
These are the 2 classic symptoms most predictive of GERD.
What are heartburn and regurgitation?
his symptom, especially if progressive, is an alarm feature that should prompt endoscopy.
What is dysphagia?
This test is indicated first in patients with alarm symptoms or complications.
What is upper endoscopy (EGD)?
PPIs work best when taken at this time relative to meals.
What is 30–60 minutes before a meal, usually breakfast?
This is the major malignancy associated with chronic Barrett-related reflux injury.
What is esophageal adenocarcinoma?
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What is Venus?
This term describes reflux symptoms without visible esophageal injury on endoscopy.
What is non-erosive reflux disease (NERD)?
Name 3 alarm features in suspected GERD.
What are dysphagia, odynophagia, weight loss, GI bleeding, anemia, or persistent vomiting?
This statement is true or false: Endoscopy is normal in many patients with symptomatic GERD.
What is true?
These nonpharmacologic measures are especially evidence-based in patients with GERD.
What are weight loss if overweight/obese and head-of-bed elevation/avoiding meals near bedtime?
This endoscopic complication can cause progressive solid-food dysphagia in chronic GERD.
What is a peptic stricture?
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What is Snow White and the 7 dwarfs?
This anatomic abnormality commonly contributes to GERD by disrupting the EGJ barrier.
What is a hiatal hernia?
This common mistake must be avoided in patients with chest pain before attributing symptoms to reflux.
What is failing to exclude cardiac causes/ACS?
This test best establishes objective reflux burden when the diagnosis is uncertain.
What is ambulatory reflux monitoring/pH testing, often pH-impedance?
This intervention may be appropriate for selected patients with objective GERD, especially severe reflux esophagitis, large hiatal hernia, or persistent troublesome symptoms despite optimized therapy.
What is antireflux surgery, such as fundoplication?
A 58-year-old man has 10 years of poorly controlled GERD and progressive solid-food dysphagia. EGD shows a distal esophageal stricture. Biopsy shows intestinal-type columnar epithelium with goblet cells but no dysplasia. What is the diagnosis, and what is the most appropriate management?
Barrett esophagus without dysplasia. Treat with long-term PPI therapy and endoscopic surveillance. Endoscopic eradication therapy is not routinely indicated for nondysplastic Barrett esophagus.
Which ancient civilization built Machu Picchu?
What is the Inca?
This pathophysiologic mechanism is the major driver of most reflux episodes.
What are transient lower esophageal sphincter relaxations (TLESRs)?
Chronic cough, hoarseness, and asthma fall into this symptom category, which is less specific for GERD.
What are extraesophageal manifestations?
This esophageal test is not primarily diagnostic for GERD, but is useful to rule out achalasia and before antireflux surgery.
What is esophageal manometry?
A patient still symptomatic on once-daily PPI should first be assessed for this common issue before calling it refractory GERD.
What is improper PPI timing/adherence?
A 62-year-old man with chronic GERD undergoes EGD for worsening reflux. Biopsy from a segment of Barrett esophagus shows high-grade dysplasia without evidence of invasive carcinoma.What is the preferred next step in management?
Endoscopic eradication therapy, typically endoscopic resection of any visible lesions followed by radiofrequency ablation of the remaining Barrett mucosa. High-grade dysplasia carries a substantial risk of progression to esophageal adenocarcinoma and should not be managed with surveillance alone.
What is the only food that technically never spoils?
What is Honey?