mash
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A
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| rida
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Agree with A
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| mani
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you mean its achlasia?? i think its reflux esophagitis and anything among the options in its favor is B
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| Sakaki-
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Is there increased gastric acid secretion in GERD?
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| mash
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this is GERD and its causes r
failure of the lower esophageal sphincter to relax after a swallow
contraction defects of lower esophageal sphincter
increased acid secretion
but mcc is either failure of lower esophageal sphincter to relax or contraction defets
wats the ans?
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| Sakaki-
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When the lower esophageal sphincter relaxes, doesn't it "open"? So failure to relax would mean that it would be closed, which I doubt would be a cause of GERD. Isn't that achlasia, as mani stated?
I do, however, agree that this is a case of GERD.
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| Bela
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I think the answer is B. Anyway, I don't think there is an answer for this cuz I think I saw it on NBME and there are no answers for those qs.
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| mash
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yeah dat was a v stupid ans...
actually the cause of GERD is abnormal relaxation follg a swallow..(normally it is transient but if it is prolonged then acid regurgitates into the esophagus)
diffuse spasm may cause GERD too but dysphagia is a feature ..
it cant be A
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| Bela
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I have a question:
Isn't Barrett's one of the causes of GERD? Isn't achalasia one of the reasons that leads to GERD? So, wouldn't achalasia indirectly be a cause of GERD?
So:
Achalasia-->Barrett's-->GERD
Any thoughts?
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| mash
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isnt it GERD----> barretts--->adenoca
im not sure whether achalasia predisposes to GERD or not
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| Bela
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Mash,
I think I remember one question from long time ago where they present a pt with barrett's and they give you enough clues to lead you to think that she has scleroderma (which presents with achalasia). That's why I made the connection. However, I am not sure :?
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| rida
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I know with GERD, when you have acid reflux into the esophagus, inorder to protect itself from the acid, it will undergo metaplasia which is barretts, and that predisposes to adenocarinoma. One of the doctors once told me that always remember barretts and achalasia both predispose to adenocarcinoma.
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| mani
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so sfter all the discussion, whats gonna be the answer? i already said only thing that favors GERD is B. any comments?
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| Sakaki-
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Is C a possibility? Diffuse spasm of the esophageal musculature could lead to disordered secondary peristalsis and result in GERD.
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| Renegade
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Important to remember that Barret is a premalignant lesion, consequence of GERD, not the other way around. On the other hand, achalasia has a few more causes... you might remember a well-known 3rd world disease that causes it, no? :wink:
I'd say A, because it occurs at night and after large meals. Doesn't meal ingestion actually relieves pain from hypersecretion of gastric acid? And if acid was the cause, why at night? As far as I know, we don't make more acid while we sleep :shock: ...
If they wanted a «Diffuse spasm of the esophageal musculature» case, they'd force us to DD it from a. pectoris... diferent symptoms.
Yes, A. Only problem is the pts age... only 45. I was expecting someone older. :|
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| Bela
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Renegade,
It states in the question stem that the pt has this feeling after Large meals and when he sleeps. Don't you think that the acid production in the stomach is proportional to the amount of food ingested?
Because some of the reasons for GERD are:
1) Pregnancy (baby pushing up abd organs)
2) Pts eating large amounts of food + full of fats etc. etc.
Why at night? I don't think that at night you produce more HCl; it's just that at night you're lying down in a horizontal position  , which makes it easier for the acid to pass into the esophagus (especially if the LES is loose, not contracted). That's why they suggest these pts use pillows while they're sleeping.
Anyone has some other ideas? :?
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| drrabines
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Well, This is a NBME question and there is an E option, that is:
E- Inapropriate relaxation of the lower esophageal sphincter.
And I think this is the right answer.
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| Ahab
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"Renegade" wrote:
Important to remember that Barret is a premalignant lesion, consequence of GERD, not the other way around. On the other hand, achalasia has a few more causes... you might remember a well-known 3rd world disease that causes it, no? :wink:
South american trypanosoma cruzi, transmitted by the reduviit bug (chagas disease).
Given the age (male 45) and the 6 mths history i would be happy on a history alone to have a suspicion of H. Pylori
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| Malaysian
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I have not done NBME so I can't say if there is another option....in that case my votes with drrabines.
If this was all to it in the answers as menioned above then the best option to fit is B.
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