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Continuing Medical Education Questions: March 2013

DeVault, Kenneth R MD, FACG; Crabbe, Lindsay MD; Dinani, Amreen MD; Kassam, Zain MD

Author Information
American Journal of Gastroenterology: March 2013 - Volume 108 - Issue 3 - p 329
doi: 10.1038/ajg.2013.39
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Questions:

  1. When is esophageal manometry recommended in the evaluation of GERD?
    • A. To confirm the clinical diagnosis of GERD
    • B. Prior to consideration of anti-reflux surgery
    • C. When patients fail once daily PPI therapy
    • D. For patients who exhibit extra-luminal symptoms of GERD
  2. What is NOT a recommended initial treatment for a patient with GERD symptoms?
    • A. Weight loss
    • B. Elevate head of bed
    • C. Start twice daily PPI therapy for 2 months, then decrease to once daily indefinitely
    • D. Administer PPI therapy 30–60 minutes prior to meals
  3. What are the endoscopic findings of the corresponding grade for the Los Angeles (LA) classification for esophagitis?
    • A. Grades A–D
    • Grade A: One (or more) mucosal break 5 mm or less that does not extend between the tops of two mucosal folds
    • Grade B: One (or more) mucosal break more than 5 mm long that does not extend between the tops of two mucosal folds
    • Grade C: One (or more) mucosal break that is continuous between the tops of two or more mucosal folds but that involves less than 75% of the circumference
    • Grade D: One (or more) mucosal break that involves at least 75% of the esophageal circumference
    • B. Grades I–V
    • Grade I: Single or isolated erosive lesion(s) affecting only one longitudinal fold
    • Grade II: Multiple erosive lesions, non-circumferential, affecting more than one longitudinal fold, with or without confluence
    • Grade III: Circumferential erosive lesions
    • Grade IV: Chronic lesions: ulcer(s), stricture(s) and/or short esophagus; alone or associated with lesions of grades 1–3
    • Grade V: Columnar epithelium in continuity with the Z-line, non-circular, star-shaped or circumferential; alone or associated with lesions of grades 1–4
    • C. Grades A–E
    • Grade A: Single mucosal lesion Grade B: Two mucosal lesions
    • Grade C: Three mucosal lesions
    • Grade D: Greater than 3 mucosal lesions
    • Grade E: Circumferential involvement of esophagus with greater than 3 mucosal lesions
    • D. Grades I–IV
    • Grade I: Erythema of lower esophageal junction extending less than 5 cm
    • Grade II: Erythema of lower esophageal junction extending greater than 5 cm with 1–2 mucosal ulcerations
    • Grade III: Erythema of lower esophageal junction extending greater than 5 cm with 3 or more mucosal ulcerations
    • Grade IV: Circumferential ulceration of lower esophagus with ulceration
© The American College of Gastroenterology 2013. All Rights Reserved.