Gastroesophageal Reflux Disease (GERD) - CRASH! Medical Review Series

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(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)

[@woloabel]

Friday, October 21, 2022: Gastroenterology: Gastroesophageal Reflux Disease (GERD), is Pathology of the Lower Esophageal Junction (LEJ) having excessive relaxation therein and resulting in Acidic Backflow of Stomach Acid onto the Esophagus, otherwise "Heartburn"; Ax: 1) Idiopathic; Risk Factors (RFx): 1) Obesity, 2) Older Age (> 50), 3) Family History (FHx), 4) Hiatal Hernia, 5) Certain Drugs (Calcium Channel Blockers [CCB]); SSx: 1) Epigastric Pain, 2) "Sore Throat", 3) Hoarseness, 4) Cough, 5) Wheezing, 6) "Bad Taste in Mouth", 7) Vomiting, 8) Alarm Symptoms: 1) Weight Loss/Cachexia, 2) Anemia, 3) Heme Positive Stool (Stool Texture/Color is Tarry and Dark), 4) Dysphagia, 5) Odynophagia, 6) Long-Standing GERD (Chronic), 7) Age (> 50); Epigastric Pain Differential: 1) Idiopathic (MCC), 2) GERD, 3) Peptic Ulcer Disease (PUD), 4) Gastritis, 5) Pancreatitis, 6) Other Causes, 7) Neoplasia/Cancer (Gastric, Esophageal, Pancreatic, etc), 8) Referred or Misappropriated Pain (Pelvic Pain, etc); DDx: 1) Angina Pectoris (Stable, Unstable, Coronary Artery Disease and EKG Diagnosis) otherwise Chest Pain, 2) Esophageal Motility Disorder (Achalasia and Dysphagia), 3) Peptic Ulcer; Cx: 1) Aspiration Pneumonia (Wheezing, Hoarseness and Cough on Px and Documentation of such); 2) Eroded Tooth Enamel (Longstanding GERD); Dx: 1) Upper Endoscopy (All Subjects > 50 and those with Alarm Symptoms), 2) Clinical Diagnosis (Clear GERD Symptomatology), 3) 24 Hour pH Monitoring and Manometry (Persistent Symptoms and Treatment or Those with Questionable GERD); Tx: Proton Pump Inhibitors (PPIs as in Esomeprazole,. Omeprazole, etc) is the Standard of Care (SOC); 2) Histamine 2 Antagonists/Inhibitors (Second Line Tx and Less Effective); 3) Lifestyle Modifications is always advisable: 1) Weight Loss, 2) Food and Water Avoidance within 3 Hours of Bedtime, 3) Avoidance of Caffeine, Nicotine, Alcohol, Chocolate, Fried/Fatty Foods, 4) Smaller Meals, 5) Head Elevation at Night (~ 8 inches), 6) Left Lateral Decubitus Position Sleep Advice; 4) Surgery as the most precise and Late-stage Treatment: 1) Nissen Fundoplication for Chronic and Refractory GERD; and Complications (Cx) of GERD: 1) Strictures and 2) progression to Barrett's Esophagus (Squamocolumnar Metaplasia due to Chronic Acid Exposure; Dx is made with Upper Endoscopy and Biopsy [Goblett's Cells are indicative of the Colonification of the Esophagus) and 3) Malignancy (Dysplasia and Anaplasia) as in Adenocarcinoma of the Esophagus. For Low-Grade Dysplasia Upper Endoscopy q6 Months thereafter; High Grade Dysplasia warrants Distal Esophagectomy. When Histologic Changes are the only finding Endoscopy is mandated every 2-3 Years thereafter. PPIs are always Indicated in these Patients/subjects. Goodness, my first Francoanaplastic Diagnosis. Just Kidding. The Subject was successfully treated with intermittent PPIs Therapy and later developed Gastric Adenocarcinoma demanding a Gastrectomy. MD Paul Bolin, zu essen natuerlich ist aber zu Leben zu essen schade und verboden ist. Heil!

[@fatetakamachi77]

Thank you for reuploading it, Paul!

[@DrDinooshDeLivera]

Thank you so much! I absolutely loved the whole series!

[@umairaarif6535]

Thanks for your hard work, Dr. Bolin.

[@sabiaafreen4481]

Thank you so much for your videos, Dr Bolin!

[@cmetube]

Merry Christmas Paul and everybody watching!

[@deedeefleur]

Thank you Dr. Paul! ♥️

[@user-ld3do8ye5g]

Thank you very much... We are waiting you to update other videos please....

[@marwaa2895]

Thank you for your efforts doctor 👏 very helpful

[@vksharma1131]

video is so good and explanation is so easy

[@Idlaff]

Thanks so much

[@imperiusss]

Sir please make a playlist of Dermatology. It would help us out a lot!! thank you

[@intimaaabueid8461]

Thank you ☘️☘️

[@DrSulaimaan]

Thanks doctor 👨‍⚕️

[@Almedicosis]

thank you so much😄

[@mikkelbakjensen2350]

Thank you for the video - now with sound ;-)

[@mennaassal2882]

thank you so much ! would you please review the cardiology videos? alot of them has no audio :( :( :(

[@sarahsen6504]

Thank u

[@yemjoe525]

Nice videos , by the way, what textbook do you prepare your slides from

[@juansebz]

Thank you very much for the video upload Doc. Paul. I have an endoscopy/colonoscopy procedure coming up on the 19th of this month. First time doing an endoscopy so I have a question. How long do you have to have an acid reflux issue to chronically damage the esophagus?. This is my biggest concern here. Personally, I’ve been having issues with it since late march 2023 (7 months!). And last but not least, does having a gurgling sensation in the throat quite often and numbness or sensitiveness in the lower gum also means there’s problem with the esophagus?. It will really help if you could answer me. Thank you!.

[@samphonnetgamgee5625]

I watched this about 1 year ago and now suddenly the volume is too low.

[@clarewu8125]

I keep trying to become a patron but the webpage won't load.

[@samreenmulla3926]

Does this work for Australian Medical Council excluding the screening criteria.

[@komaddog]

Just in time

[@brittanygulker2051]

No mention of pregnancy as a risk factor for developing GERD?

[@siavashkhazali5842]

Eroded tooth enamel could be a sign of bulimia as well.

[@omidceazar5951]

What are the long term consequences of Chronic PPI use? Should patients with GERD but without Barretts be on chronic PPIs

[@queerveganmedstudent9893]

Hypomagnesemia has been coming up lately.

[@Hasan-wp9qw]

Some videos don’t have sound, why don’t you reupload them ?

[@mehmetkaya3711]

You need to add Acute Pancreatitis into the differential diagnosis.

[@nelidabasulto3786]

Please, teléfono de el Doctor.

[@nelidabasulto3786]

Dirección y teléfono del Doctor,