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The Curbsiders Internal Medicine Podcast


Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Dec 16, 2019

Delve into the diagnosis and management of GERD and dyspepsia with Dr. Amy Oxentenko (@AmyOxentenkoMD), Gastroenterologist and the Internal Medicine Residency Program Director, Associate Chair for the Department of Internal Medicine, and Professor of Medicine at Mayo Clinic in Rochester, MN. Our discussion features a review of the standard presentations of GERD and dyspepsia, alarm symptoms and who needs referral for endoscopy or other specialized testing (pH, impedance testing, screening for Barrett’s esophagus). Additionally, we comprehensively cover proton pump inhibitor (PPI) therapy including: choice of agent, dose, frequency, how taper, how to counsel patients about risk, what labs should be monitored and the use of adjuvant therapies like H2 blockers, antacids and even carafate. After this episode, you will be flexing on reflux!

ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

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Credits

  • Written and Produced by: Paul Williams MD, FACP, Beth Garbitelli
  • CME Questions: Beth Garbitelli, Matthew Watto MD, FACP
  • Infographic: Beth Garbitelli 
  • Cover Art: Kate Grant MBChB DipGUMed
  • Hosts:  Matthew Watto MD, FACP; Paul Williams MD, FACP   
  • Editor: Matthew Watto MD, FACP (written materials); Clair Morgan at Nodderly.com
  • Guest: Amy Oxentenko MD

Time Stamps

  • 00:00 Intro, disclaimer, guest bio
  • 02:47 Guest one-liner, Picks of the Week*: Reality TV Shows: Survivor  and Naked and Afraid; Book: Blind Eye: The Terrifying Story Of A Doctor Who Got Away With Murder by James B. Stewart
  • 08:50 Favorite failure
  • 10:55 Best Advice
  • 13:34 A case of GERD, Defining GERD, basic pathophysiology and risk factors
  • 19:18 A bit more on diagnosis of GERD
  • 21:56 Chest pain, mimics of GERD, red flag symptoms
  • 25:12 Are labs required for diagnosis?, testing for Barrett’s esophagus
  • 28:43 Who needs lifelong PPI therapy?, Choice of PPI
  • 33:09 Lifestyle changes and GERD
  • 37:50 H2 blocker vs PPI therapy, Risks of PPI therapy
  • 44:40 How to counsel patients about the risks and benefits of PPI therapy; Recent 3 year RCT investigating safety of PPI therapy
  • 48:18 Adjuvant therapy and further workup for patients with refractory GERD
  • 51:57 pH and impedance studies
  • 54:29 Duration of PPI therapy; Intermittent and On-Demand PPI therapy; Weaning off long term PPI therapy
  • 59:30 Who may benefit from anti-reflux surgery
  • 63:48 Dyspepsia
  • 68:17 Workup of dyspepsia; Definition and diagnosis of functional dyspepsia
  • 74:09 2nd line therapy for dyspepsia (TCAs, Buspirone, GI psychologist, STW 5, complementary and alternative therapies, etc.)
  • 78:13 Take Home Points; Plugs

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Disclosures

Dr. Oxentenko reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Oxentenko A, Williams PN, Garbitelli B, Watto MF. “#188 GERD and Dyspepsia with Amy Oxentenko MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 16, 2019.