GERD interactive EGHAP 15 Nov. 2024

1-Mrs N., a 36-year-old non-diabetic, non-HTN female, complains of 3 months burning sensation in the throat and chest with regurgitation of food particles after meals, and eructation, with no relation to effort. No dysphagia or weight loss. What is the most probable cause of her symptoms?

• Ischemic heart disease.

• Achalasia of the cardia.

• Gastroesophageal reflux.

• Cancer esophagus

• Dissecting aortic aneurysm

Answer explanation

Mrs. N.'s symptoms of burning sensation and regurgitation after meals, without dysphagia or weight loss, are characteristic of gastroesophageal reflux disease (GERD), making it the most probable cause.

2-On clinical assessment, there was no pallor or Cx LNs, no epigastric masses, with normal vital signs. What is the best next step in here management (in addition to lifestyle modifications)?

• Refer for diagnostic EGD.

• Start a morning dose of 20 mg omeprazole once/day for 4-8 wks.

• Start dual dose H2 inhibitors for 4-8 wks.

• Start dual dose Omeprazole 20 mg for 4-8 wks.

• Start Vonoprazan 20 mg before breakfast.

Answer explanation

Starting a morning dose of 20 mg omeprazole once/day for 4-8 weeks is appropriate for managing symptoms related to acid reflux or gastritis, especially when no serious conditions are indicated by the clinical assessment.

3-After 8 weeks, she came for a review, but she still suffers some symptoms, with more increases in the night while sleeping. What should be the appropriate step to take now?

• Shift to omeprazole 40 mg in the morning 4-8 wks.

• Shift to omeprazole 40 mg in the evening 4-8 wks.

• Add famotidine 20 mg at night to the current treatment 4–8 wks.

• Shift to omeprazole 20 mg twice daily 4–8 wks.

• Proceed to upper GIT endoscopy.

Answer explanation

Shifting to omeprazole 20 mg twice daily addresses persistent symptoms effectively, especially with nighttime increases. This regimen enhances acid suppression, providing better symptom control over the current treatment.

4-After 6 weeks, she came again suffering from the same symptoms with little or even no response. What should be the appropriate step to take now?

• Shift to dexlanzoprazole 60 mg in the morning.

• Add Alginate therapy to her current regimen

• Add Amitriptyline 20 mg at night

• Add itopride TDS.

• Proceed to upper GI endoscopy.

Answer explanation

Shifting to dexlanzoprazole 40 mg may provide better acid suppression, while proceeding to upper GI endoscopy is crucial to rule out any underlying conditions that could be causing persistent symptoms.

5-What is the most probable optical diagnosis?

• Non-erosive reflux disease (NERD)

• Eosinophilic esophagitis (EoE)

• Barrett's esophagus (BE)

• Erosive esophagitis (EE) LA-B

• Siding hiatal hernia (HH)

6-Based on this video endoscopy, what should be done now?

• End the procedure, start Vonoprazan 20 mg daily.

• Take biopsies from the esophagus before ending the procedure.

• Refer for anti-reflux surgery.

• Start TCA or SSRIs.

• Refer for HRM-pH impedance.

7-After the biopsy results are shown, what do you think should be done ?

• Start oral corticosteroids.

• Refer for HRM & pH impedance.

• Continue acid suppression and add prokinetics.

• Start SSRIs or TCA.

• Refer for anti-reflux surgery.

8: What is the best choice for our case?

• Optimize acid suppression therapy.

• Add TCA

• Try Baclofen

• Refer for laparoscopic fundoplication.

• Consider ARMA