Etiology
Which part of the digestive system is directly irritated by stomach acid in GERD?
The esophagus
This is the MAIN anatomical dysfunction that leads to GERD
Opened / latent LES
When do we do a repeat endoscopy after erosive esophagitis?
3 months
What drug directly neutralizes stomach acid without reducing production?
Antacid
What are the three phases of swallowing?
Oral, pharyngeal, esophageal
Name 3 risk factor categories of GERD
Hiatal hernia: impair LES function and esophageal acid clearance, contributing to more severe GERD.
Impaired/blocked esophageal clearance
Delayed gastric emptying (peristalsis)
Refluxate composition: super acidic mixture- pepsin, bile, pancreatic enzymes
Mucosal resistance / damage
Visceral hypersensitivity (NERD)
Obesity
How does weight loss improve GERD symptoms?
Eating lower fat foods and eating less means avoiding foods that would increase stomach acid levels
Give at least 2 lifestyle adjustments that help with GERD.
Head to bed elevation
Eliminating smoking and alcohol
Minimize high fat food
Weight loss in overweight/obese patients
How can obesity contribute to GERD?
By increasing intra-abdominal pressure, which can push stomach contents into the esophagus.
Name the MAIN risk factor (and one more risk factor for good luck!) for esophageal adenocarcinoma versus squamous cell carcinoma of the esophagus
smoking, obesity, achalasia, Barrett esophagus
Squamous cell carcinoma: Smoking
alcohol, hot liquids, Plummer-Vinson, diet high in nitrosamines, HPV, achalasia
How many days does esophageal epithelial turnover take?
approx 11 days
What is the direct target of omeprazole?
H+/K+ ATPase in parietal cells
How can pregnancy contribute to the development of GERD?
Pregnancy increases intra-abdominal pressure due to the growing fetus and hormonal changes that can relax the LES, both contributing to increased reflux risk.
In Barrett's esophagus, what is the name of the junction that is extended from the stomach into the esophageal mucosa?
Squamocolumnar junction or Z junction
Give three defining factors of alarm severity.
Weight loss, hematemesis, melena, dysphagia
What are the psychological impacts of GERD
Sleep disturbance
Daily life affected by regurgitation symptoms
Increased depression and anxiety
This condition can cause hardening and tightening of the skin and connective tissues, including the muscles of the esophagus, leading to weakened esophageal motility and increased risk of reflux.
Scleroderma
In Achalesia, two inhibitory neurons in the myenteric plexus are atrophied. What are the two neurons, and what do they do?
NO: relaxation of LES, regulate peristalsis, vasodilation, protect esophageal mucosa
VIP: smooth muscle relaxation, stimulates secretion of water and electrolytes in the pancreas, bile, and intestines, inhibits gastrin-stimulated gastric acid secretion, increases gastrointestinal motility
What is the smoking effect on GERD?
Weakens the LES by reducing the physiological pressure
Give 5 general side effects of reflux medication
Hypokalemia
Acid rebound
nausea, abdominal pain, diarrhoea, vomiting, constipation
Vit b12 and iron malabsorption, calcium malabsorption
risk of c diff infection