GASTROENTEROLOGY ARTICLE OF THE WEEK
February 10, 2005
DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005;100:190-200
1. Expected rates of symptomatic relief and esophagitis healing with therapy include
a. <5% healing on placebo
b. 50% healing on H2RA
c. 95% healing on PPI
d 83% symptom improvement on PPI
e. 60% symptom improvement on H2RA
2. Situations in which double dose PPI may be indicated include
a. as empiric treatment for non-cardiac chest pain
b. for patients who present with severe symptoms prior to starting therapy
c. for patients with erosive esophagitis
d. for patients with suspected supra-esophageal complications
e. for patients with severe esophageal dysmotility
True or False
3. Degree of GERD symptoms do not predict degree of esophagitis or correlate with likelihood of developing Barrett’s esophagus
4. Reflux of barium during UGIS correlates with symptomatic GERD in over 90% of patients
5. Patients with GERD symptoms but grossly normal endoscopy should undergo esophageal biopsies to detect esophagitis
6. Baclofen, a GABA receptor type B agonist has been shown to reduce GER, probably by reducing the number of transient LES relaxation episodes.
7. Results of esophageal manometry prior to fundoplication changes medical/surgical management in up to 1/3 of patients
8. Postoperative dysphagia after anti-reflux surgery appears to be more common with the laparoscopic approach and the use of Nissen as opposed to Toupet procedures
9. Endoscopic therapies for GER normalize esophageal acid exposure in <35% of patients.