GERD | Clinical Medicine
Summary
TLDRThis 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
- ๐ฅ Gastroesophageal reflux disease (GERD) is a condition where stomach acid flows back into the esophagus, causing discomfort.
- ๐ Common symptoms of GERD include heartburn and dyspepsia, which can manifest as burning chest pain and upper abdominal pain.
- ๐จ Complications of GERD can range from esophagitis and strictures to aspiration, which can lead to laryngitis, worsening asthma, and even cancer.
- ๐ก The process of metaplasia is when squamous cells in the esophagus transform into columnar cells due to prolonged exposure to stomach acid.
- ๐ฌ Dysplasia is the term for the transformation of columnar cells into neoplastic cells, which can be a precursor to esophageal cancer.
- ๐ Causes of GERD include a low lower esophageal sphincter tone, hiatal hernias, increased hydrochloric acid production, and high intragastric pressure.
- ๐ญ Lifestyle factors like smoking, alcohol, and caffeine can decrease lower esophageal sphincter tone and exacerbate GERD.
- ๐ฅ GERD is often diagnosed clinically, but an ECG may be needed to rule out heart issues if chest pain is present.
- ๐ Treatment for GERD typically involves medications like proton pump inhibitors (PPIs) or H2 blockers to reduce stomach acid production.
- โ๏ธ In severe cases, a Nissen fundoplication surgery may be necessary to reinforce the lower esophageal sphincter and prevent acid reflux.
- ๐ 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.
Outlines
๐ Introduction to Gastroesophageal Reflux Disease (GERD)
The speaker begins the lecture by introducing the topic of Gastroesophageal Reflux Disease (GERD), also known as GIRD. They encourage viewers to check the description for additional resources like notes and illustrations to aid in understanding the lecture. The speaker then delves into the basic concept of GERD, explaining how stomach acid can reflux into the esophagus, causing discomfort and potentially serious health issues. Symptoms such as heartburn and dyspepsia are discussed, along with the more severe complications that can arise from chronic GERD, including esophagitis, stricture formation, and the increased risk of esophageal cancer due to the metaplastic changes in esophageal cells caused by constant exposure to stomach acid.
๐ Understanding the Progression and Causes of GERD
This section further explores the progression of GERD from normal esophageal cells to columnar cells through a process called metaplasia, and then potentially to neoplastic cells through dysplasia. The speaker emphasizes the importance of recognizing the stages of disease progression, which can lead to conditions like Barrett's esophagus and adenocarcinoma. The lecture then moves on to discuss the various causes of GERD, including a low lower esophageal sphincter tone, hiatal hernias, increased hydrochloric acid production, and high intra-gastric pressure. The speaker also explains how certain medications can help manage GERD by inhibiting acid production or blocking the histamine 2 receptors, which can stimulate acid secretion.
๐ญ Lifestyle Factors and Conditions That Exacerbate GERD
The speaker identifies and explains the factors that can decrease lower esophageal sphincter tone, such as smoking, alcohol consumption, and caffeine intake. They also discuss the role of hiatal hernias in GERD, particularly sliding hernias, and how conditions like pregnancy, obesity, large meals, and gastroparesis can increase intra-gastric pressure, contributing to the disease. The lecture highlights the importance of understanding these factors to manage GERD effectively, including the role of certain medical conditions like Zollinger-Ellison syndrome, which can increase hydrochloric acid production.
๐ฉบ Diagnostic Approach and Treatment Options for GERD
This part of the lecture covers the diagnostic approach to GERD, emphasizing the importance of differentiating GERD from other conditions like acute coronary syndrome, especially when patients present with chest pain. The speaker suggests an empiric proton pump inhibitor (PPI) trial as a diagnostic tool and outlines the steps to take if symptoms do not improve, including looking for alarm symptoms that might indicate more severe complications. The lecture also touches on additional diagnostic tools like esophageal manometry and pH monitoring. The speaker discusses the treatment of GERD, focusing on the suppression of hydrochloric acid production through the use of PPIs or H2 receptor antagonists, and the importance of addressing underlying causes like weight loss in obese patients.
๐ Surgical Intervention and Cancer Surveillance in GERD
The final section of the lecture discusses surgical options for patients with refractory GERD, such as Nissen fundoplication, which aims to reinforce the lower esophageal sphincter and prevent acid reflux. The speaker also stresses the importance of cancer surveillance in GERD patients, especially those with chronic disease or alarm symptoms, advocating for regular endoscopies to check for dysplasia and take prompt action if needed. The lecture concludes with a summary of the key points and a reminder of the importance of understanding and managing GERD to prevent serious complications.
Mindmap
Keywords
๐กGastroesophageal Reflux Disease (GERD)
๐กHydrochloric Acid
๐กHeartburn
๐กDyspepsia
๐กEsophagitis
๐กStricture
๐กAspiration
๐กMetaplasia
๐กDysplasia
๐กProton Pump Inhibitors (PPIs)
๐กEmpiric PPI Trial
Highlights
Gastroesophageal reflux disease (GERD) involves stomach acid refluxing into the esophagus, causing issues like heartburn and dyspepsia.
The downside of acid reflux is the potential for damage to the esophagus, leading to conditions like esophagitis and strictures.
Acid reflux can also cause aspiration, leading to issues like laryngitis and worsening asthma.
Chronic GERD can increase the risk of esophageal cancer due to the constant inflammation.
The process of cells adapting from squamous to columnar cells is called metaplasia.
Dysplasia is the term for the transformation of columnar cells into neoplastic cells in the esophagus.
The progression from metaplasia to dysplasia can lead to conditions like Barrett's esophagus and adenocarcinoma.
Four main reasons for GERD include low lower esophageal sphincter tone, hiatal hernia, increased hydrochloric acid production, and high intragastric pressure.
Smoking, alcohol, and caffeine can decrease lower esophageal sphincter tone, contributing to GERD.
A sliding hernia is a common type of hiatal hernia associated with GERD.
Increased intragastric pressure can be caused by pregnancy, obesity, large meals, and gastroparesis.
Certain conditions like Zollinger-Ellison syndrome can increase hydrochloric acid production, exacerbating GERD.
GERD is generally diagnosed clinically, often starting with an empiric proton pump inhibitor (PPI) trial.
Alarm symptoms like dysphagia, vomiting, anemia, and weight loss may indicate severe complications and require further investigation.
Esophageal manometry and pH monitoring can help diagnose GERD when other tests are inconclusive.
Treatment for GERD involves suppressing hydrochloric acid production, often with PPIs for severe cases and H2 blockers for milder cases.
Fundoplication surgery may be necessary for refractory GERD that does not respond to medical therapy.
Regular endoscopic surveillance is important for GERD patients, especially if there is any dysplasia present.
Transcripts
what's up Ninja nerds in this video
today we're going to be talking about
gastrosoph agile reflux disease also
known as gird what I want you guys to do
before we get started on this video I
want you guys to take a second go down
the description box below we got links
to our website where it'll be a lot of
awesome notes and illustrations that I
think will be super critical for you
guys to follow along with me during this
lecture also if you guys benefit from
this lecture please support us by
hitting that like button commenting down
in the comment section and please
subscribe all right let's start talking
about gastral reflux disease so gird is
this basic concept it's super super
basic in which things like nasty stuff
like hydrochloric acid contents from the
stomach unfortunately will just decide
to move its way upwards into the
esophagus now when that happens what's
the downside of that what's the actual
problematic issue with this actual
hydrochloric acid getting into the
esophagus well if we zoom in here what
you'll notice is that this acid
substance within the actual esophagus
can cause a lot of problems one of these
things is it can lead to just common
sensation such as heartburn and this may
manifest if you will with this Burning
retro sternal chest pain that usually
occurs after meals and it's really bad
when you lay
supine sometimes because the esophagus
is not just here within the chest but it
can actually come down here just to the
epigastric level you may even have epep
gastric pain we call this dyspepsia it's
that burning pain that you may have
right here in the epigastrium so two
very common manifestations is going to
be heartburn and
dyspepsia this is super critical and the
reason why is because this hydrochloric
acid is going to be coming up into the
esophagus causing a lot of burning and
inflammation now the question I have for
you guys is what are some of the
complications that are associated with
gastr Solage or reflux disease so the
basic concept is hydrochloric acid is
coming up into the esophagus it's
ripping it up causing heartburn
dyspepsia but it can also do a lot of
other things like what it can really
inflame the esophagus and start
ulcerating it and this can lead to
esophagitis additionally with the
esophagitis sometimes patients can come
in presenting with like things like
oasia like a lot of pain with swallowing
that's one common thing the other
problem here is that as you kind of
cause this constant inflammation over
time if this esophagus is being inflamed
and inflamed and inflamed it'll then
undergo a fibrotic reaction to heal but
it'll narrow the actual Lumin of the
esophagus and this can lead to stricture
formation another potential complication
associated with this gastro Solage or
reflux disease is that sometimes this is
very very interesting with this
hydrochloric acid not only can It
inflame the Esopus lead to strictures
but sometimes the actual contents can
move its way into the airway
and this could lead to features of a lot
of what's called kind of a reflux or an
aspiration type of event so you want to
watch out for
aspiration now the problems with this
very quickly is if you aspirate some of
this Hydrochloric contents into the
larynx it can cause laryngitis what's a
common manifestation of that voice
changes if it goes into the bronchos it
can inflame the bronchos and lead to
inflammation of the bronchos what could
that worsen asthma so the other ways
that I want you to think about gird
presenting is not just with esophagitis
or strictures but aspiration that can
lead to heness larynx and worsening
Asthma bronchial inflammation boom
roasted what's another potential
complication you know if you erode and
ulcerate the esophagus there's blood
vessels that are lining that you can
erode into the actual blood vessel and
lead to bleeding so you want to watch
out for GI
bleeding ways that GI beds can present
is this can have a patient who presents
with like a lot of maybe anemia right so
maybe it's an actual uh a lab finding or
they can present with a lot of fatigue
that's another particular thing the last
and scariest complication of gastrosoph
reflux disease over chronic and chronic
and chronic inflammation is you increase
the risk of what's called esophageal
cancer with that being said one of the
very interesting Concepts here that we
have to dig into just quickly for the
pathophysiology is whenever you look at
normal cells of the esophagus it's
actually stratified squamous so it's
stratified squamous so here we'll
actually write on the side here this
should be squamous
cells but whenever you expose the actual
Squam cells over a long period of time
to a lot of hydrochloric
acid this will cause the cells to have
to adapt when the cells have to adapt
they undergo something called
metaplasia so whenever they adapt they
change into a different type of cell and
this is going to be called columnar
cells
this process where they go from squamous
to columnar you know what that's called
This is called metaplasia let's actually
write that here this process here is
called
metaplasia all right beautiful so going
from the Squam cells to the columnar
cells is called metaplasia but then if
you continue and continue to cause more
erosive damage more inflammation you can
turn these columnar cells into
neoplastic cells so you can turn these
into to neoplastic cells let's stick
with our color here which we did was
blue so again this is our neoplastic
cells so this here going from columnar
cells to neoplastic cells is called
dysplasia so one of the biggest things
to understand here is with this
metaplasia aspect that's really a very
specific type of intermediate so I want
you guys to understand kind of the
progression here is that the progression
of this disease is you have something
called
barrettes and then over time this baret
will then progress to what's called
adino
carcinoma so this is the metaplasia this
is the dysplasia so this is the concept
that I want you guys to understand okay
now let's go and let's talk about the
different causes of Girt all right my
friends so gastrosoph reflux disease
heartburn dyspepsia from the reflux of
the hydrochloric acid we know the
complications associated with it
esophagitis strictures aspiration we
also know that you can have gi bleeds
and we know that you can have a Soph
cancer the question that you have to ask
yourself is why is the hydrochloric acid
going up into the esophagus as much it
is as it is causing these
complications there's four particular
reasons one of the reasons is that this
part here this is a problematic area for
us this area here is called the lower
esophagal sphincter it's supposed to be
nice and tight and prevent things like
Hydrochloric hydrochloric acid from
going up into the esophagus what if the
tone is really low that's one particular
mechanism so a low lower esophageal
sphincter
tone another particular mechanism that
can cause this is that there is a defect
somewhere here so you know the esophagus
is supposed to go up through this little
area here called the esophageal Hiatus
but in certain patients they have a
defect within that Junction and it
slides upwards and if it slides upwards
above the actual esophageal Hiatus this
is a very significant problem for gird
you know what that's called where parts
of the esophagus slides up above the
esophagal hatus this is called a hiatal
hernia remember that hiatal
hernia Okay the third particular problem
here is that the hydrochloric acid that
you're producing by the stomach is much
more so if you have hydrochloric acid
going up into the Esopus it's going to
burn it but what if you had a lot more
hydrochloric acid you're likely going to
cause more symptoms the more
hydrochloric acid the more severe the
actual gird can be so another particular
problem here is that we have cells of
the stomach that is just banging out
hydrochloric acid that's another
particular mechanism is increased
hydrochloric acid
production all right let me take you
through a quick mechanism here of why
this is a problem and how we can
actually treat this so here we have a
couple parietal cells you know parietal
cells are cells that make hydrochloric
acid there's a couple ways that they do
this one way that they do this is they
use these kind of like proton potassium
ATP Aces to push out things like
potassium and pro I'm sorry push out
things like protons and these protons
are what make the hydrochloric acid
contents super super acidic so there's
one thing that's the proton pumps but
you also have little receptors here on
these cells that tell them to actually
stimulate and increase the production of
hydrochloric acid you know what these
are these are histamine 2 receptors so
what are these particular receptors here
these guys here are
called histamine 2
receptors
when these receptors are stimulated they
increase they increase the hydrochloric
acid production and this is super
important because you know when we talk
about pharmacology if we give drugs that
block this proton pump like proton pump
inhibitors you would decrease the
hydrochloric acid production if we give
drugs that block the histamine from
binding to the H2 receptors you would
block hydrochloric acid production
that'll come into play when we talk
about the actual pharmacology okay the
last particular mechanism here is that
you have a very high inter gastric
pressure imagine the pressure in your
stomach is higher than the pressure
within your esophagus where are things
going to want to go from high pressure
to low pressure things will decompress
into the esophagus so that's the last
particular problem here is you're going
to have a patient who has very high
intragastric
pressure all right so out of all of this
these are the four reasons why the
patient would develop a very nasty G
gastrosoph reflux disease what I want to
do is I want to quickly talk about what
are the things that decrease the lower
Sagel sphincter tone what are the actual
basic type of hiatal hernia that is
really really highly associated with
gird what increases hydrochloric acid
production and what increases inter
gastric pressure so let's come down here
and let's go through these and let's
write them all down because again I
think this will help you with the
repetition first one decrease the lower
esophagal sphincter
tone next one is you have AAL
Heria
third one is you have high in gastric
pressure and the fourth mechanism is you
have increased hydrochloric acid
production okay we have to now say what
is the reasons why you have a low
esophagal sphincter tone one of these is
because the patient is smoking drinking
alcohol or they're just consuming tons
and tons of caffeine these are very very
common triggers so I want you to
remember these particular
causes all right so again smoking
alcohol caffeine are triggers that lower
the esophagal fter tone all right H
hernias what is the most common type
associated with gird I want you to
remember sliding hernas sliding
hernas the next thing I want you to
remember is what are the things that can
increase the intragastric pressure
causing it to decompress the contents
into the esophagus pregnancy
obesity as well as very large meals and
one other disease called
gastroparesis so again pregnancy obesity
very large meals gastroparesis which is
a disease associated with diabetes it's
where the nerves of the actual stomach
aren't actually working properly so the
stomach can't contract if you can't
contract can you empty things into the
actual duodenum no so all the stomach
does is distend distend distend pressure
Rises can decompress into the actual
esophagus the last one here is you
increase hydrochloric acid production
the big things are things like ineds
alcohol smoking and a rare rare disease
called Zinger Ellison
syndrome okay again ineds alcohol
smoking zeling or Ellison syndrome which
is a rare disorder where you're actually
have a tumor like a pancreatic tumor
that pumps out gastrin you know what
gastrin does a hydrochloric acid
production cranks it up all right so
these are the mechanisms behind
gastrosoph reflux disease now let's dig
into the diagnostic approach all right
so gird heartburn we know the particular
three pathophysiological processes
intragastric pressure GE AB uh gastral
Junction abnormality or reduced lower
solal sphincter tone we know the three
complications that they can present with
how do we diagnose this well gir's
generally a clinical diagnosis but I
think it's important to remember that
often times they'll present with
heartburn and so heartburn kind of
present sometimes presents like chest
pain and here's the other thing
sometimes patients who present with
heartburn or maybe even a little bit of
like epigastric abdominal pain dyspepsia
we don't want to miss an inferior mind
and so you should always in any
complaint of chest pain obtain an ECG
and depending upon the ECG results get
your opponents if you see any evidence
of St elevation reciprocal change es and
positive tronin this is not gird this is
potentially an acute coronary syndrome
and you should completely change your
diagnostic approach here but if it comes
back normal and there is no evidence of
any true changes such as troponin
elevation no ST depression t-wave
inversions or elevations then I'm
starting to think it could be more gird
related so how do I do this it's more of
just you try a treatment and see if it
improves it what I do is I would
initiate an empiric PPI trial I'll give
them a proton pump inhibitor that'll
suppress the hydrochloric acid
production in the stomach and if that
happens I'll reduce the hydrochloric
acid moving into the esophagus and
causing the heartburn sensation and
complications do they get better if they
do it's probably gir if they don't then
you can't completely exclude that it's
not gir so then what else could we do if
maybe their symptoms are not
significantly better with the PPI then I
really want to start asking myself the
question is there any severe
complications am I missing something so
I look for alarm symptoms is there
dysphasia because that could identify a
strcture is there vomiting that could
identify a stricture is there anemia
this could be indicative of a GI bleed
or sometimes even cancer and is there
weight loss this could be indicative of
a stricture or cancer if I have any of
these alarm symptoms I have to get an
EGD with a
biopsy the reason why is gird can lead
to potential complications and I want to
see is this just esophagitis from from
the reflux or does this look really bad
and I got some really bad like reflux
like related structures
here and then worst case scenario is is
there cancer and so sometimes this may
lead you to kind of find potential
complications related to the gird I
think one of the big things though is if
a patient has a normal EGD they have not
improved with the empiric PPI trial then
I think the next thing that you could
potentially do is say let me just rule
out any other type of esophageal dis
order so I'm going to get esophagal
manometry and if I do that I can rule
out an esophagal motility disorder
because if all they have is their lower
Sagal sphincter tone is reduced but all
the other mid distal kind of tone is
normal it's likely gir and if that's the
case I've ruled out any other Sage Gil
motility
disorder the other thing that I can do
is I can get pH monitoring this is where
I take kind of a little U it's kind of
like a pH sensor goes through the nose
down into the esophagus and it has
different pH sensors at each different
point here of the esophagus what happens
is in a patient who has very bad gird
hydrochloric acid will move up into the
esophagus and it'll trigger this pH
sensor so the amount of times that this
pH sensor picks up that the pH is lower
than it's supposed to be it'll trigger a
triggering of the score activation and
what happens is this will lead to the
act the calculation of something called
a demer score and the demer score
greater than 14.7 how they came up with
that I'm not sure really helps me to
identify that this sensor was picking up
drops and pH pretty frequently and it
really adds to the diagnosis of gird so
that's how I would go about it empiric
PPI trial they improve it's gir if they
have alarm symptoms get an EG with
biopsy if that's normal but they're
still not better with the PPI trial rule
out that it's not an esophagal motility
disorder and then from there try and do
the actual pH monitoring to definitely
see if they have the evidence of
gird now we've identified gird how do we
treat it it's really pretty
straightforward we got to suppress
hydrochloric acid production because
that's the Crux of it all obviously it's
about treating the underlying causes so
in obesity what should you do lose
weight in patients who have some type of
uh maybe trigger such as caffeine reduce
your caffeine if you're smoking stop
smoking if you drink alcohol reduce your
alcohol intake these are things that
potentially can be
reversed but otherwise it should always
start with trying to suppress the
hydrochloric acid production in patients
with severe gird so really bad heartburn
maybe on top of that they have atypical
findings like cough laryngitis worsening
of their asthma and maybe they even have
a gird complication maybe they have
reflux of esophagitis maybe they have
strictures maybe on top of that they've
had GI bleeds or maybe they have some
type of barit esophagus you need to get
them on a PPI right away and keep that
going going for at least 8 weeks and
then reevaluate if I can actually step
down on that PPI ppis work by kind of
suppressing hydrochloric acid production
right so they block these hydrogen
proton ATP channels reduce hydrochloric
acid secretion that reduces a lot of the
gird and complications associated with
gird now if the patient has mild gird
they just have some mild heartburn they
have no evidence of any complications no
esophagitis no strictures no barretts
nothing to that effect I think h 2as are
a little bit more appropriate the reason
why is ppis they can interfere with
other drugs and reduce the actual
bioavailability of those drugs because
they can interact with the cytochrome
p450 complex and on top of that it
actually has been associated with like
electrolyte abnormalities such as
hypomagnesemia and CI so it's important
to remember that and so sometimes h2ras
are just a little bit more safe and not
as having as many complications so this
would be things like foden that's a very
common one renadine whereas pprs are
things like ome prol pentool Lano prasol
so how does an H2 work it's the same
concept it's going to suppress the
actual histamine response at the
receptor site histamine actually helps
to stimulate hydrochloric acid
production so if I give them this it'll
block the actual histamine at that
receptor reduce the hydrochloric acid
secretion and reduce gird and the any
for formation of any complications of
that sense often times when patients
come in if they have severe gird and
gird complic put them on a PPI for 8
weeks review to see if they're getting
any better and see if you can step down
to an
H2 if they can't then maybe you have to
go back to the lowest dose of the PPI
that they were on where they were
completely controlled if they're on an
H2 and they develop any worsening gird
or G complications then you have to upti
trate them to a
PPI let's say that you've had them on
Max PPI and they're still not getting
any better they're still having very bad
gird they're having gird related
complications then you need to go to
What's called a Nance fundoplication so
what that is is you're going to
basically take a part of the fundus and
you're going to you're basically going
to help to reinforce the lower sofel
sphincter so you're going to take the
fundus and literally wrap this sucker
around the lower sofro sphincter and
tighten that area up and so look at this
thing I took the fundus wrapped it
around it and then I sued it tight and
now I have a very very tight lower Sagel
sphincter which will reduce into the
hydrochloric acid leaking back up into
the esophagus reducing the gird related
complications so that'd be a niss
application if they have refractory gird
that's not responsive to Medical therapy
and then also Improvement or at least
treating of their underlying
cause last thing is gird has a very high
risk of cancer especially if it's
chronic so you need to survey these
patients if they have any alarm symptoms
such as vomiting they have dysphasia
they have anemia they have weight loss
you really should be doing an EGD if
they have no dysplasia on an EGD then
you should at least check it every 3 to
5 years but if they do have any evidence
of dysplasia you want to catch it right
then and there and ablate that area of
cancer or resect that area of cancer and
that's something that we'll talk about a
little bit more when we talk about
esophageal cancer in the actual oncology
section all right my friends that covers
gird I hope that made sense I hope that
you guys enjoyed it and as always until
next
[Music]
time
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