GERD and Peptic Ulcer Disease Quiz

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Questions and Answers

Which of the following lifestyle changes is NOT recommended for treating GERD?

Weight loss

Eating smaller meals

Increasing intake of coffee and chocolate (correct)

Avoiding late night meals

Which of the following is a red flag symptom for GERD, suggesting the need for further evaluation?

GERD symptoms resolving with over-the-counter antacids

Regurgitation of food with a bitter taste

Occasional heartburn after a large meal

Onset of GERD symptoms after age 60 (correct)

What does the term "step-up therapy" refer to in the context of GERD management?

Gradually increasing the potency of medications until symptoms are controlled (correct)

Starting with the most potent medication and gradually decreasing it as symptoms improve

Using a combination of multiple medications simultaneously

Combining medications with lifestyle modifications to achieve symptom control

Which of the following diagnostic tests is commonly used for patients with refractory GERD or red flag symptoms?

All of the above (D) Signup and view all the answers

What is a common complication of GERD that can be detected through esophagogastroduodenoscopy (EGD)?

Both A and B (B) Signup and view all the answers

What is the most common complication of peptic ulcer disease?

Bleeding (C) Signup and view all the answers

What were the original treatments for peptic ulcer disease?

Antacids, vagotomy, and partial gastrectomy (B) Signup and view all the answers

What type of bacteria was discovered in biopsies of patients with gastric ulcers?

Helicobacter pylori (C) Signup and view all the answers

What was the name of the 80-year-old Russian man treated by Dr. Marshall?

He is not named in the text (D) Signup and view all the answers

What was the initial reaction of the medical community to the discovery of H. pylori?

Skepticism and ridicule (B) Signup and view all the answers

How did Dr. Marshall first discover that H. pylori was associated with peptic ulcer disease?

He observed a correlation between the presence of H. pylori and ulcer symptoms in his patients (B) Signup and view all the answers

What is the approximate percentage of adults who were affected by peptic ulcer disease in the past?

10% (C) Signup and view all the answers

What was the significance of the accidental overnight culturing of H. pylori samples?

It confirmed the presence of H. pylori in the samples obtained from patients with GI symptoms (B) Signup and view all the answers

What condition is characterized by a combination of atrophic glossitis, esophageal webs, and iron deficiency anemia?

Plummer-Vinson syndrome (B) Signup and view all the answers

Which of the following treatments is typically used for symptomatic esophageal rings, also known as Schatzki’s ring?

Dilation (A) Signup and view all the answers

Which type of esophageal condition involves a saccular outpouching usually found near the upper esophageal sphincter?

Zenker’s diverticulum (D) Signup and view all the answers

In which patient population is infectious esophagitis primarily observed?

Immunocompromised hosts (D) Signup and view all the answers

What is the primary pathophysiological feature of achalasia?

Failure of the lower esophageal sphincter to relax (C) Signup and view all the answers

What is the prognosis for a patient experiencing UGI bleeding when advanced age is a factor?

Worse outcomes (A) Signup and view all the answers

What is the first step in the evaluation and management of a patient with large black stools?

Assess for signs of shock (D) Signup and view all the answers

What condition is characterized by a large, tortuous submucosal artery in the GI tract?

Dieulafoy’s Lesion (C) Signup and view all the answers

Which factor is NOT associated with worse outcomes in UGI bleeding?

Elevated blood pressure (B) Signup and view all the answers

What is the recommended action for patients with CAD experiencing GI bleeding related to aspirin use?

Continue ASA if high CV risk (C) Signup and view all the answers

What initial hematocrit value should be expected for a patient who has vomited 1.5 liters of blood?

45% (B) Signup and view all the answers

What is a significant risk factor for rebleeding in patients with H pylori-associated bleeding ulcers?

Continued NSAID use (B) Signup and view all the answers

What is the mortality rate when treatment for esophageal rupture is not performed?

100% (C) Signup and view all the answers

What is the effect of H pylori eradication on reflux esophagitis?

Doubles occurrence (B) Signup and view all the answers

Which factor increases the risk of NSAID-induced peptic ulcer disease (PUD)?

High dosage of NSAIDs (B) Signup and view all the answers

Which of the following is NOT a proven strategy to decrease NSAID-induced gastrointestinal bleeding risk?

H2-blockers (C) Signup and view all the answers

What is a characteristic manifestation of autoimmune chronic gastritis?

Achlorhydria and elevated gastrin levels (A) Signup and view all the answers

Which of the following patients is at high risk for NSAID-induced gastrointestinal bleeding?

A 30-year-old with a history of ulcers (A), A 62-year-old on aspirin therapy (D) Signup and view all the answers

What is the primary recommended prophylactic treatment for stress ulcers in critically ill patients?

Proton pump inhibitors (A) Signup and view all the answers

What is a consequence of the loss of intrinsic factor in autoimmune chronic gastritis?

Pernicious anemia (C) Signup and view all the answers

Which statement about chronic gastritis is true?

Type B is often caused by chronic H.pylori infection. (A) Signup and view all the answers

What does dysphagia of solids primarily indicate?

Mechanical obstruction within the esophagus (C) Signup and view all the answers

Which condition is NOT considered an obstructive cause of dysphagia?

Achalasia (C) Signup and view all the answers

What is the most common cause of esophageal stricture?

Chronic GERD (C) Signup and view all the answers

Eosinophilic esophagitis is primarily caused by which of the following?

Eosinophil-predominant inflammation due to food antigens (C) Signup and view all the answers

What is a recommended treatment for eosinophilic esophagitis?

Elimination diets for certain food antigens (B) Signup and view all the answers

Study Notes

Clinical GI - Esophagus and Stomach

The presentation covered Gastroesophageal Reflux Disease (GERD) and esophageal and stomach disorders.
The objectives included understanding GERD mechanisms and treatments, dysphagia causes and workup, Peptic Ulcer Disease (PUD) presentations and risk factors, upper GI bleeding causes, gastric motility disorders, and their mechanisms and treatments.
It is important to note that the presenter emphasized the common entities in clinical medicine and preparing students for board exams using straightforward, examination-style questions.

GERD

Effortless regurgitation of stomach contents into the esophagus or mouth causing discomfort (heartburn, acid taste) is a key characteristic.
It is the most common GI complaint in outpatient clinics, with approximately 9 million visits per year.
A US survey indicated that 22% of respondents experienced GERD in the last month.
GERD worsens with delayed gastric emptying and increased intra-abdominal pressure (e.g., ascites, pregnancy).
Symptoms include burning sensation (pyrosis) in the retrosternal area, usually after large meals and lying down, and regurgitation of gastric contents with an unpleasant taste.
Diagnosis is based on symptoms and response to antacids or antisecretory therapy. Testing is generally not necessary but reserved for refractory disease or red flag symptoms.
Red flag symptoms include onset after age 60, unexplained weight loss, GERD for more than 10 years, difficulty swallowing (dysphagia), painful swallowing (odynophagia), family history of upper GI cancer, and exertional symptoms.
Tests for GERD (refractory cases or red flags): ambulatory pH monitoring, esophagogastroduodenoscopy (EGD), manometry, and upper GI series (esophagogram).

GERD Treatment

A three-step approach is proposed:
- Step 1: Lifestyle modifications including weight loss, stopping smoking and alcohol, eating smaller meals, avoiding late-night meals, and elevating the head of the bed.
- Step 2: Medications (e.g., antacids, H2 blockers, Proton Pump Inhibitors (PPIs).
- Step 3: Surgery (e.g., Nissen Fundoplication, Transoral Incisionless Fundoplication (TIF), Magnetic Device insertion)
Foods to avoid include coffee (regular and decaf), chocolate, peppermint, soft drinks, fatty foods, spicy foods, tomatoes, and citrus fruits/juices.

PUD

A mucosal defect in the stomach or duodenum that extends through the muscularis mucosa layer is a key characteristic.
Up to 70% of PUD cases are asymptomatic.
Symptoms of symptomatic PUD include epigastric tenderness, RUQ, LUQ tenderness, gastric ulcer pain with eating, duodenal ulcer pain several hours after eating and at night.
Complications can include bleeding, gastric outlet obstruction, penetration/fistulization, and perforation.

H. Pylori

H. Pylori is a bacterium associated with PUD.
H. Pylori was linked to up to 10% of adult PUD cases, but this is less common now.
There are various treatment regimens for H. pylori, including combinations of antibiotics, PPI, and bismuth.Confirmation of cure through repeat testing of urea breath test or stool antigen about 1 month after antibiotic completion is advised.

Upper GI Bleeding

The prevalence of upper GI bleeding is high, with roughly half a million hospitalizations annually and a cost of $4.5 billion.
It has various causes, including duodenal ulcers, gastric ulcers, gastritis, esophageal varices, Mallory-Weiss tears, AV malformations, and esophageal rupture.
Screening of cirrhosis patients and using β-blockers for prophylaxis, plus endoscopic hemostasis, vasopressin, somatostatin, octreotide, and TIPS placement for treatment of acute bleeds are key strategies in dealing with esophageal varices.
Considerations in the evaluation of esophageal rupture include full-thickness tear of the esophagus and Bohaave's syndrome, which can be caused by vomiting.
Diagnosis of an esophageal rupture includes free air on a CXR or CT scan.
High mortality is associated with this condition: 100% without surgery, 25% with surgery and antibiotics.
Other causes encompass angiodysplasia (AV malformation), Dieulafoy's lesion, and specific factors affecting the prognosis of upper GI bleeding.
Management of GI bleeding includes initial stabilization with maximal IV fluids, transfusion of RBCs if hemoglobin is below 7 g/dL, and upper endoscopy within 24 hours.
Subsequent treatment includes testing for H. pylori, discontinuation of NSAIDs if possible, and possible use of COX-2 inhibitors with PPIs if NSAIDS must be continued.

Other Stomach Disorders

Additional stomach disorders, such as gastroparesis (delay in food transition without obstruction), include idiopathic causes, diabetic autonomic dysfunction, medications (opioids, anticholinergics, dopamine agonists), post-surgical injury to the vagus nerve, and neurologic conditions (e.g., multiple sclerosis).
Diagnostic tests include EGD or upright abdominal X-ray, and sometimes scintigraphy to measure radiolabeled food movement.
Lifestyle modifications for gastroparesis include tolerance of liquids, avoiding fatty or acidic foods, and avoiding tobacco and alcohol.
Medications include promotility agents (Metoclopramide, Domperidone, erythromycin) and antiemetics (diphenhydramine, ondansetron).

Clinical Cases

Various clinical cases are highlighted throughout the presentation including detailed patient characteristics, symptoms, diagnostic testing, likely diagnoses, and treatment approaches. The slides present several clinical cases with questions regarding treatment.

Definitions

Definitions of terms like dysphagia, odynophagia, globus, Achalasia, and other significant medical terms are present.

Additional Points

The presentation covers important topics such as the 2022 ACG guidelines for PPI therapy (emphasizing when to continue PPI treatment after symptom resolution) and the concept of step-up/step-down PPI therapy in managing GERD.
There were discussions on risks associated with NSAIDs and their potential roles in GI bleeding and treatments for ulcers/gastrointestinal infections.
A detailed understanding of different forms of gastric motility disorders (including achalasia, distal esophageal spasm, hypercontractile disorder, and systemic sclerosis).
Importantly, presentation highlighted Zollinger-Ellison syndrome, Menetrier's disease, and the implications for those conditions.

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Description

Test your knowledge on the management, symptoms, and complications of GERD and peptic ulcer disease. This quiz covers lifestyle changes, diagnostic tests, and historical treatments related to these gastrointestinal conditions. Assess your understanding of H. pylori's role and its implications in ulcers.