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Diagnosis and Management of Gastroesophageal Reflux Disease (GERD)

Definition
Presentation
Medical Management
Extraesophageal Symptoms
Long-Term PPI Issues
Diagnosis Algorithm
Refractory GERD
Surgical and Endoscopic
Diagnosis and Management ... Gastroesophageal Reflux ... Disease (GERD) ... Extraesophageal Symptoms ... Gastroesophageal #Reflux
Gastroesophageal Reflux Disease (GERD) - Summary

GERD: Diagnosis
• Heartburn (substernal burning sensation) and acid regurgitation
• Chest pain
Extraesophageal
Gastroesophageal Reflux ... Testing Ambulatory reflux ... reduction • Avoid “trigger ... Gastroesophageal #Reflux ... Disease #diagnosis #management
Feedback Loop: Growth Hormone (GH)
Growth Hormone:
 • Liver -> GHR activates JAK-STAT pathway -> Incr IGF1
Growth Hormone (GH ... lipolysis Signs/Symptoms ... abn lipid • GH ... #FeedbackLoop #endocrinology ... #pathophysiology
Growth Hormone Excess - Pathogenesis and clinical findings
 • Acromegaly and gigantism share the same pathophysiology
share the same pathophysiology ... GH excess prior ... diagnosis #signs #symptoms ... #endocrinology ... #pathophysiology
GERD and Recommended Lifestyle Modifications
 • Avoid fatty meals
 • Avoid carbonated beverages
 • Avoid citrus,
GERD and Recommended ... citrus, if it triggers ... symptoms • Eat ... #reflux #acid # ... Modifications #management
Acromegaly - Diagnosis and Management Summary - GrepMed Handbook 

Clinical Presentation: 
 • Classic Acromegaly: frontal
Diagnosis and Management ... malignancy Pathophysiology ... MRI+contrast Management ... #Endocrinology ... #Treatment #Pathophysiology
Leukostasis vs Tumor Lysis Syndrome
Leukostasis:
 • Pathophysiology: Large, immature blasts and high WBC count cause hyperviscosity
Leukostasis: • Pathophysiology ... hyperviscosity syndrome • Triggers ... Lysis Syndrome: • Pathophysiology ... into serum • Triggers ... TLS #diagnosis #management
Pituitary Mass Effects - Pathogenesis and Clinical Findings
 • Pituitary turnors are almost always a benign
following order; GH ... Signs / Symptoms ... #SideEffects #endocrinology ... mnemonic #GLFTAP #pathophysiology
Efficacy of lifestyle interventions for GERD
Weight loss:
 - Improvement of GERD symptoms and esophageal pH
 -
symptoms and esophageal ... esophageal pH and symptoms ... acidity but not symptoms ... symptoms Cessation ... #reflux #management
Esophageal Necrosis
Etiology:
 - Ischemia and Gastric Outlet Obstruction with GERD may be inciting events
 - Associated
Obstruction with GERD ... injury (by acid reflux ... promote esophageal reflux ... melena - Other GI symptoms ... Necrosis #diagnosis #management