Chest pain of unknown origin (CPUO): role of the esophagus Richard I. Rothstein, MD Chief, Section of Gastroenterology and Hepatology Dartmouth Hitchcock Medical Center Professor of Medicine Dartmouth Medical School
Los Angeles (LA) Grade Classification of Erosive Esophagitis LA Grade C LA Grade D One or more mucosal breaks no longer than 5mm, not bridging the tops of mucosal folds One or more mucosal breaks bridging the tops of mucosal folds involving <75% of the circumference One or more mucosal breaks bridging the tops of mucosal folds involving >75% of the circumference One or more mucosal breaks longer than 5mm, not bridging the tops of mucosal folds LA Grade B LA Grade A Lundell et al. Gut. 1999;45:172-180.
The spectrum of heartburn frequency and severity is similar in GERD patients with and without esophagitis Severe Moderate Mild Severity of heartburn Smout 1997 Patients without esophagitis Patients with esophagitis
GERD Therapeutic Options Prokinetics OTC or prescription H2RAs “ First - aid” : Life-style modifications and antacids Endoscopic techniques (plication, RF, implant) Surgery (Lap Nissen fundoplication) OTC or prescription PPIs Treatments
Life-style Modifications Reduce weight Elevate head of bed Stop smoking Eat small meals, no late meals, reduce fat Consider alternatives to reflux-promoting drugs e.g., theophilline, anticholinergics
Avoid reflux-promoting agents e.g, alcohol, coffee; some foods