GERD | Clinical Medicine

Summary

This video educates viewers on Gastroesophageal Reflux Disease (GERD), detailing its causes, symptoms like heartburn and dyspepsia, and complications such as esophagitis and cancer. It explores diagnostic methods, including PPI trials and EGD, and treatment options from lifestyle changes to medications like PPIs and H2 blockers. The video also stresses the importance of monitoring GERD patients for potential cancer risk.

Takeaways

• 🔥 Gastroesophageal reflux disease (GERD) is a condition where stomach acid flows back into the esophagus, causing discomfort.
• 🔑 Common symptoms of GERD include heartburn and dyspepsia, which can manifest as burning chest pain and upper abdominal pain.
• 🚨 Complications of GERD can range from esophagitis and strictures to aspiration, which can lead to laryngitis, worsening asthma, and even cancer.
• 🌡 The process of metaplasia is when squamous cells in the esophagus transform into columnar cells due to prolonged exposure to stomach acid.
• 🔬 Dysplasia is the term for the transformation of columnar cells into neoplastic cells, which can be a precursor to esophageal cancer.
• 🛑 Causes of GERD include a low lower esophageal sphincter tone, hiatal hernias, increased hydrochloric acid production, and high intragastric pressure.
• 🚭 Lifestyle factors like smoking, alcohol, and caffeine can decrease lower esophageal sphincter tone and exacerbate GERD.
• 🏥 GERD is often diagnosed clinically, but an ECG may be needed to rule out heart issues if chest pain is present.
• 💊 Treatment for GERD typically involves medications like proton pump inhibitors (PPIs) or H2 blockers to reduce stomach acid production.
• ✂️ In severe cases, a Nissen fundoplication surgery may be necessary to reinforce the lower esophageal sphincter and prevent acid reflux.
• 🔄 Regular endoscopic surveillance is crucial for GERD patients, especially if dysplasia is detected, to monitor for potential cancer development.

Q & A

What is Gastroesophageal Reflux Disease (GERD)?

GERD, also known as GORD, is a condition where stomach acid frequently flows back into the esophagus, causing heartburn and other potential complications.

What are the common symptoms of GERD?

Common symptoms of GERD include heartburn, dyspepsia (epigastric pain), and a burning sensation in the chest that often occurs after eating.

What is the main cause of GERD?

The main cause of GERD is the reflux of hydrochloric acid from the stomach into the esophagus, which can be due to a low lower esophageal sphincter tone, a hiatal hernia, increased hydrochloric acid production, or high intragastric pressure.

What is the relationship between GERD and esophagitis?

GERD can lead to esophagitis, which is the inflammation of the esophagus caused by the irritation from stomach acid.

How can a hiatal hernia contribute to GERD?

A hiatal hernia occurs when the upper part of the stomach pushes into the diaphragm, causing the lower esophageal sphincter to be above its normal position, which can lead to acid reflux.

What are some complications associated with GERD?

Complications of GERD can include esophagitis, stricture formation, aspiration, laryngitis, worsening asthma, GI bleeding, and an increased risk of esophageal cancer.

What is the process of cells changing from squamous to columnar called?

The process of cells changing from squamous to columnar is called metaplasia.

How can lifestyle factors affect GERD?

Lifestyle factors such as smoking, drinking alcohol, and consuming caffeine can lower the lower esophageal sphincter tone, increase hydrochloric acid production, or raise intragastric pressure, contributing to GERD.

What is the diagnostic approach for GERD?

The diagnostic approach for GERD often begins with an empiric trial of a proton pump inhibitor (PPI) to see if symptoms improve. If there are alarm symptoms, an EGD with biopsy may be performed. Esophageal manometry and pH monitoring may also be used to confirm the diagnosis.

How is GERD typically treated?

Treatment for GERD typically involves suppressing hydrochloric acid production with medications like proton pump inhibitors (PPIs) or H2 receptor antagonists. Lifestyle modifications and sometimes surgical intervention, such as a Nissen fundoplication, may also be necessary.