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Git j club gerd acg guides21
This document summarizes the key points discussed in a surgery club meeting on GERD. It was noted that GERD remains one of the most common conditions seen in clinical practice. While PPIs are still first-line treatment, there has been increased scrutiny of their long-term safety profile and overprescribing. New data on surgical and endoscopic interventions was also discussed. The document presents several case studies and questions on the best next steps for management.
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Git j club gerd acg guides21
- 1. Kurdistan Board GEH/GITSurgery J Club 2021 Supervised by Professor Dr. Mohamed Alshekhani.
- 2. Introduction: A lothas changed, much remains the same. GERD is among the most common diseases seen by GEists, surgeons& PCPs. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing&approach to patient management have evolved. Scrutiny of PPIs has increased considerably. Although PPIs remain the medical treatment of choice for GERD, multiple publications have raised questions about adverse events, raising doubts about the safety of long-term use&increasing concern about overprescribing of PPIs..
- 27. Conclusion: GERD isamong the most common diss seen by GEists,surgeons& PCPs. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing&approach to patient management have evolved. During this time, scrutiny of PPIs has increased considerably. Although PPIs remain the medical treatment of choice for GERD, multiple publications have raised questions about adverse events, raising doubts about the safety of long-term use&increasing concern about overprescribing of PPIs. New data regarding the potential for surgical & endoscopic interventions have emerged.
- 28. Conclusion: A 65-year-oldWhite man presents with symptoms of heartburn, regurgitation& dysphagia for solid foods for 3 months. His symptoms occur 4–5 times a week &have increased recently. He reports eating a high-fat diet with frequent late-night snacks& caffeinated drinks due to long work hours& project deadlines. He drinks 1–2 beers/d, does not smoke tobacco. He has used antacids periodically. He reports no melena or fever, weight is stable. He has occasional dry cough, no hoarseness. On exam, vitals normal,BMI 32,not pale. Chest,cardiac, abdominal exam are unremarkable. What would you advise as the best next step? A. An 8-week trial of PPI use once a day before dinner. B. An upper endoscopy. C. A barium swallow study. D. A 24-hour pH test off acid blocking medications.
- 29. Conclusion: A 55-year-oldwoman presents with chronic reflux symptom including heartburn& chest pain for 10 years. She has used several PPIs over the years with variable control in her symptoms. She does try to adhere to an anti-reflux diet& lifestyle. She avoids recumbency for 2–3 h after dinner. She does not smoke or drink alcohol. She reports her symptoms currently occur 3 times a week despite use of PPI twice daily 30 min before breakfast &dinner. She has undergone an OGD off PPI which showed LA grade B esophagitis. She does have a 3 cm hiatal hernia. Her weight is stable, BMI 33. She does not report melena, cough, or hoarseness. On exam her vital signs are stable. Chest, cardiac&abd are unremarkable. In addition to advising weight loss, what would you recommend next to manage her reflux symptoms? A. Add a histamine 2 receptor antagonist at nighttime B. Refer for anti-reflux surgery C. Esophageal impedance-pH on PPI D. Bravo testing off PPI.
- 30. Conclusion: A 40-year-oldman presents with a persistent dry cough& mild hoarseness for a year. He has no shortness of breath, chest pain,regurgitation, dysphagia, or heartburn. He does not smoke tobacco&otherwise in good health. He is not on any medications. He has been evaluated by a pulmonologist& ENT specialist. He was told his cough and hoarseness may be due to acid reflux disease as chest x-ray, pulmonary function tests, blood work, allergy tests&indirect laryngoscopy are normal. The patient’s physical exam is unremarkable.What would you recommend as the best next step in the management of this patient? A. An upper endoscopy. B. A trial of high dose PPIs for 8 weeks C. pH testing off PPI. D. 24 pH testing on PPI.