348 Ch 347. GERD and Esophageal Disorders

GERD (gastroesophageal reflux disease) = symptoms or complications from gastric content reflux；typical symptoms：heartburn + regurgitation；atypical：cough, asthma, hoarseness, dental erosion；complications：esophagitis, strictures, Barrett’s esophagus (specialized intestinal metaplasia → adenocarcinoma)；diagnosis：clinical + PPI trial + EGD for alarm features + 24h pH monitoring (ambulatory)；treatment：lifestyle + PPI (foundation) + step-up/down + surgery/endoscopic for select；Barrett’s：surveillance + radiofrequency ablation for dysplasia；esophageal disorders 其他：(1) eosinophilic esophagitis (EoE) — allergic, dysphagia + food impaction; PPI/STC + dupilumab (LIBERTY-EoE)；(2) achalasia — LES dysfunction, bird beak; pneumatic dilation, POEM, Heller myotomy；(3) diffuse esophageal spasm；(4) scleroderma esophagus；(5) esophageal cancer — adenocarcinoma (Barrett-related) + squamous (smoking + alcohol)；2024 emerging：vonoprazan (potassium-competitive acid blocker), Ozanimod and other targeted EoE biologics。