ASGE Annual GI Advanced Practice Provider Course (Virtual) (Day Two) | March 2026-GERD and Barrett’s: Diagnosis and Endoscopic Therapy

Video Transcription

Video Summary

The talk reviews gastroesophageal reflux disease (GERD) and then Barrett’s esophagus. GERD affects ~15% worldwide and ~20% in Western countries (weekly heartburn). Typical symptoms are heartburn and regurgitation, often post‑meal, with bending, or lying flat; sensitivity of symptoms is limited. Extra‑esophageal complaints (cough, hoarseness, throat clearing, asthma, globus) are common but nonspecific. GERD is multifactorial: impaired acid clearance/motility, decreased buffering, hiatal hernia or LES disruption, and delayed gastric emptying. Complications include erosive esophagitis, bleeding/iron deficiency, peptic strictures/Schatzki ring, and progression to Barrett’s and adenocarcinoma.<br /><br />Management often starts with an empiric high‑dose PPI trial, then step down. Endoscopy is recommended for alarm features (especially dysphagia), atypical symptoms, and older patients; severe esophagitis (LA C/D) should be re‑scoped after 8–12 weeks of PPI to rule out Barrett’s. Objective testing includes Bravo pH monitoring off therapy (acid only) and 24‑hour pH‑impedance (acid and non‑acid; on or off therapy depending on the question), typically preceded by manometry.<br /><br />Barrett’s requires endoscopic columnar mucosa ≥1 cm above gastric folds plus intestinal metaplasia on biopsy. Screening is suggested for chronic GERD plus risk factors. Dysplasia should be confirmed by expert pathology; endoscopic eradication (EMR for nodules, RFA for flat dysplasia; cryotherapy if RFA fails) requires repeated surveillance due to recurrence risk.

Asset Subtitle

Sarel Myburgh, APRN, CNP, MS

Keywords

gastroesophageal reflux disease (GERD)

proton pump inhibitor (PPI) therapy

endoscopy indications and LA esophagitis grading

Bravo pH monitoring and 24-hour pH-impedance testing

esophageal manometry

Barrett’s esophagus with intestinal metaplasia

endoscopic eradication therapy (EMR, RFA, cryotherapy)