GERD Questions and Answers with Verified Solutions

GERD Questions and Answers with Verified Solutions Explain the pathophysiologic mechanisms associated with GERD -abnormal reflux of gastric contents from the stomach into the esophagus. Although transient relaxations are more likely to occur when there is normal LES pressure, the latter two mechanisms are more likely to occur when the LES pressure is decreased by such factors as fatty foods, gastric distension, smoking, or certain medications LES -Gastroesophageal reflux is associated with defective lower esophageal sphincter (LES) pressure or function. -Patients with a defective LES may have decreased gastroesophageal sphincter pressures related to... Spontaneous transient -relaxations in the LES not associated with consumption of food. -Post-prandial esophageal distension, vomiting, belching, and retching may cause abnormal relaxation of the LES. -responsible for more than half of the reflux episodes in patients with GERD and may play an important role in the development of symptom-based esophageal reflux syndromes. -The propensity depends on: degree of sphincter relaxation, efficacy of esophageal clearance, patient position (more common in recumbent, lying down, position), gastric volume, and intragastric pressure Transient increases in intraabdominal pressure (stress reflux) An increase in intraabdominal pressure such as that occurring during straining, bending over, coughing, eating, or a Valsalva maneuver may overcome a weak LES (cause LES to open), and thus may lead to reflux An atonic LES permits free reflux as seen in patients with scleroderma (due to a lack of esophageal tone; it doesn't have anything to regulate the LES relaxing and contracting) Problems with other normal mucosal defense mechanisms may also contribute to the development of GERD, such as... *Abnormal esophageal anatomy*: disruption of normal anatomical barriers by large hiatal hernias *Improper esophageal clearance of gastric fluids*: acid spends too much time in contact with the esophageal mucosa. The bicarbonate in saliva buffers residual gastric acid on the surface of the esophagus. *Reduced mucosal resistance to acid*: as mucosa becomes repeatedly exposed to refluxate, or mucosal defense goes down, H+ ions diffuse into the mucosa and may lead to cellular acidifications/ necrosis esophagitis. *Delayed or ineffective gastric emptying*: increased gastric volume may promote regurgitation feedings *inadequate production of epidermal growth factor*: reduced salivary buffering of acid: (has bicarb which please look at b) -Substances that may promote esophageal damage due to reflux in the esophagus include gastric acid, pepsin, bile acids, and pancreatic enzymes. The composition and volume of the refluxate and duration of exposure are important aggressive factors in determining the consequences of gastroesophageal reflux 2. Identify alarm symptoms that mandate further diagnostic evaluation. "Alarm symptoms" are symptoms that may be indicative of complications of GED like Barrett's esophagus, esophageal strictures, or esophageal adenocarcinoma. Some symptoms include: • Dysphagia (difficulty swallowing; common) • Odynophagia (painful swallowing which may occur with or without dysphagia) • Bleeding • Weight loss However, these symptoms are nonspecific and may be caused by other diseases, so it is important to further investigate. Diagnostic tests for GERD that may be conducted for further investigation include endoscopy, ambulatory pH monitoring test/impedance monitoring, and manometry. 3. List medications or foods that can worsen the symptoms of GERD. (pg 5) *Decrease LES Pressure* Medications: -anticholinergics -barbiturates -DHP CCBs