Gastritis & Peptic Ulcers for the NP Licensing Exam
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Gastroesophageal Reflux Disease (GERD) and Barrett’s Esophagus for Nurse Practitioner Licensing Exam
Definition
- Gastroesophageal Reflux Disease (GERD): A condition where stomach acid or bile refluxes into the esophagus due to lower esophageal sphincter (LES) dysfunction, causing symptoms like heartburn and regurgitation.
- Barrett’s Esophagus: A complication of chronic GERD in which the normal squamous epithelium of the esophagus is replaced by columnar epithelium with goblet cells, increasing the risk of esophageal adenocarcinoma.
Pathophysiology
GERD
- LES Dysfunction: Weakening or transient relaxation of the LES allows reflux of gastric contents into the esophagus.
- Hiatal Hernia: Herniation of the stomach through the diaphragm can exacerbate reflux.
- Mucosal Damage: Repeated exposure to gastric acid leads to esophageal inflammation (esophagitis), ulcers, and Barrett’s esophagus.
Barrett’s Esophagus
- Chronic Acid Exposure: Prolonged GERD causes squamous epithelium to undergo metaplasia into columnar epithelium, more resistant to acid but with a higher risk of cancer.
Clinical Features
GERD
- Heartburn: A burning sensation in the chest, often after meals.
- Regurgitation: Acidic or food contents rising to the throat or mouth.
- Dysphagia: Difficulty swallowing due to esophageal inflammation or strictures.
Barrett’s Esophagus
- Often Asymptomatic: Typically diagnosed during evaluation for GERD.
- Persistent GERD Symptoms: Some patients may experience long-standing or severe GERD.
Diagnosis
- GERD: Diagnosed clinically based on symptoms or confirmed by response to proton pump inhibitors (PPIs).
- Endoscopy: Used to evaluate for Barrett’s esophagus or in patients with alarm symptoms (e.g., dysphagia, weight loss).
- Biopsy: Confirms Barrett’s esophagus by identifying intestinal metaplasia.
Treatment
GERD
- Lifestyle Modifications: Weight loss, avoiding trigger foods (e.g., caffeine, alcohol), and elevating the head of the bed.
- PPIs: First-line therapy for reducing acid production and healing esophagitis.
Barrett’s Esophagus
- PPIs: Chronic use to reduce acid exposure.
- Surveillance Endoscopy: Regular monitoring to detect dysplasia or early cancer.
- Endoscopic Ablation: For dysplasia, radiofrequency ablation or mucosal resection is performed.
Complications
- GERD: Can lead to esophagitis, strictures, and aspiration pneumonia.
- Barrett’s Esophagus: Increases the risk of esophageal adenocarcinoma.
Key Points
- GERD is caused by LES dysfunction, leading to acid reflux and symptoms like heartburn and regurgitation.
- Barrett’s esophagus is a complication of chronic GERD, involving metaplasia and an increased risk of esophageal cancer.
- GERD is managed with lifestyle changes and PPIs, while Barrett’s requires surveillance and possible ablation for dysplasia.
- Complications include esophagitis, strictures, and an increased risk of adenocarcinoma in Barrett’s esophagus.