Deck 56: Gastroesophageal Reflux Disease

Question 1

A 54-year-old obese male comes into the clinic complaining of intermittent substernal chest pain and increased symptoms of indigestion and reflux. He says he has the pain frequently after eating a fatty meal. He has a history of hypertension and a family history of coronary artery disease. What would you do first?

A) Treat with a proton pump inhibitor.
B) Refer to a gastroenterologist for an endoscopy.
C) Obtain a cardiac evaluation.
D) Order esophageal motility studies/swallowing study to look for esophageal spasm.
E) Counsel about a low-fat, antireflux diet.

Answer 1

C

Question 2

Which is not one of the mechanisms that helps prevent damage to the esophageal epithelium?

A) Competent lower esophageal sphincter
B) Minimal to no saliva/mucous in the upper gastrointestinal tract.
C) Effective movement of contents through the esophagus
D) Secondary peristalsis sweeping refluxed material back into the stomach, which closes the lower esophageal sphincter.

Answer 2

B

Question 3

A 58-year-old female who is post lung transplant for idiopathic fibrosis comes into the clinic complaining of worsening reflux symptoms. She has suffered for many years and is questioning whether reflux could be the cause of her lung problems. How would you quantify the amount of her reflux?

A) Endoscopy
B) Manometry with pH study
C) Upper gastrointestinal series
D) Gastric emptying study

Answer 3

B

Question 4

For the previous patient, you have evaluated her with the previous test and find that she has a pathologic (very large) amount of reflux. She is responding well to medication but does not want to take it for the rest of her life. She would like to consider surgery. What would you do next?

A) Tell her that she has to take medication to alleviate her reflux.
B) Refer her to gastroenterology for an endoscopy and further preoperative testing.
C) Recommend diet modification.
D) Refer her to an upper gastrointestinal surgeon to consider surgery.

Question 5

Once you have referred her to a gastroenterologist, you are notified that she is a good candidate for surgery. You should then refer her to an upper gastrointestinal surgeon for a Nissen fundoplication.

Question 6

What is the most serious complication of GERD that requires treating and preventing reflux?

A) Esophagitis
B) Barrett's esophagus
C) Esophageal strictures
D) Respiratory complications
E) Sore throats/tooth decay

Question 7

Which of the following are etiologies of GERD? You may choose more than one answer.

A) Esophageal and gastric motility disorders
B) Esophageal mucosal damage
C) Flow and resistance issues
D) Structural and physiologic changes
E) Hormonal influences

Question 8

One of the causative factors of GERD is motility disorders. These can include delayed gastric emptying, a weak lower esophageal sphincter (LES), or transient LES relaxation causing altered gastric motility and/or weak/disordered esophageal peristalsis. Which study will best evaluate these?

A) Endoscopy
B) Esophagram
C) Manometry and pH study
D) Gastric emptying study
E) c and d

Question 9

What are some of the other factors that cause GERD? Pick the best answers (may be more than one).

A) Mucosal injury
B) Decreased saliva
C) Increased hydrochloric acid
D) Decreased mucosal blood flow
E) Hiatal hernia
F) Obstructive sleep apnea
G) All the above

Question 10

A 28-year-old female presents with complaints of indigestion and vague abdominal pain. She has been taking proton pump inhibitors for the past 6 months without much response in her symptoms. She had an abdominal ultrasound to rule out gallbladder disease that was negative. What would you do next?

A) Add an H2 blocker at bedtime.
B) Order a gastric emptying study.
C) Refer to gastroenterology for further evaluation that could include an endoscopy.
D) Send her for a rheumatologic evaluation.

Question 11

Treatment of GERD includes all the following except:

A) Smoking cessation
B) Weight loss
C) Proton pump inhibitors
D) Fluoride mouthwash

Question 12

H2 receptor antagonists work faster than PPIs.