Presentation on theme: "WILLIAM J. SALYERS, JR., MD, MPH DIVISION CHIEF/MEDICAL DIRECTOR KU WICHITA GASTROENTEROLOGY ASSOCIATE PROGRAM DIRECTOR INTERNAL MEDICINE RESIDENCY Putting."— Presentation transcript:
WILLIAM J. SALYERS, JR., MD, MPH DIVISION CHIEF/MEDICAL DIRECTOR KU WICHITA GASTROENTEROLOGY ASSOCIATE PROGRAM DIRECTOR INTERNAL MEDICINE RESIDENCY Putting Out the Fire: Prevention & Treatment of Acid Reflux & Ulcers
Goals Discuss the causes and treatments of ulcer-related disease. Discuss the causes and treatments of GERD. Review the long-term consequences of GERD. Review the use of endoscopy in management of ulcers and complications of GERD.
What is Endoscopy Examination of the gastrointestinal tract using long, thin flexible scopes. EGD Colonoscopy Enteroscopy Capsule Endoscopy Used for diagnostic and therapeutic purposes. Colon cancer screening Evaluation of abdominal pain Management of swallowing difficulty Management of bleeding
What is GERD? Gastroesophageal Reflux Disease. Backwash of acid into the esophagus. Irritates the lining of the esophagus. Occasionally caused by bile. Due to relaxation of the lower esophageal sphincter.
Treatment Lifestyle measures. Avoid trigger foods. Don’t eat 3 hours before bedtime. Keep head of bed elevated at night. Lie on your left side at night. Don’t smoke. Maintain a healthy weight. Don’t wear tight clothing. Acid suppressing medications. Anti-reflux surgery / procedures.
When Should You See Your Doctor? Symptoms of chest pain. Symptoms that occur > 2 x weekly. Taking OTC acid medications > 2 x weekly. Symptoms that interfere with your daily activities. Difficulty swallowing. Unintentional weight loss. GI bleeding.
What Are the Complications of GERD? Peptic strictures. Esophageal ulcers. Pre-cancerous changes of the esophagus (Barrett’s). Esophageal cancer.
Epidemiology Barrett’s Esophagus Premalignant lesion assoc w/ Adenocarcinoma of esophagus & GE jct. Increasing incidence of Esophageal AdenoCa in US over past 2 decades. AdenoCa accounting for > 50% esophageal cancers in US. Annual incidence of AdenoCa in BE is < 0.5% in US. Poor 5-year survival – only 13%. BE - Dx in 10 -15% pts w/ reflux undergoing EGD. Prevalence reported as high as 5.6% in pts w/o chronic reflux symptoms.
Therapy PPI to control GERD symptoms. Nissen Fundoplication may be considered for pt’s w/ controlled GERD on PPI. PPI tx &/or surgery do not reverse BE. No role for pH monitoring. Tx goal is symptom control, not pH level. Endoscopic therapy.
2011 AGA Guidelines High-Grade Dysplasia RFA, EMR, & PDT recommended. 70-80% can be successfully tx w/ endoscopic tx alone.\ Low-Grade Dysplasia “RFA should also be a therapeutic option for treatment”. >90% reversion to normal-appearing squamous epithelium.
2011 AGA Guidelines Nondysplastic “RFA, with or wthout EMR, should be a therapeutic option for select individuals with nondysplastic Barrett’s esophagus who are judged to be at increased risk for progression to high-grade dysplasia or cancer”.
Screening ACG: No recommendation – individualized in high risk patients. ASGE: “may be appropriate in selected pts w/ frequent (e.g., several times/wk), chronic, long- standing GERD (> 5 yrs).” If negative screening exam, no further screening indicated.