{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 3, Ep 1 of 3: Mechanisms and Endoscopy","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/b07ef621\"></iframe>","width":"100%","height":180,"duration":686,"description":"GERD is a failure of the antireflux barrier, not acid overproduction. Most patients have a normal resting sphincter, so transient lower esophageal sphincter relaxations are the dominant mechanism, and a sliding hiatal hernia amplifies every failure mode at once. Endoscopy grades the erosive damage, sizes the hernia, and decides treatment intensity, surveillance, and surgical candidacy from one look.\n \nTopics covered\n\nBarrier failure, not acid excess\nLES plus crural diaphragm stacked as one valve\nTransient LES relaxations as the main mechanism\nSliding hiatal hernia amplifies every failure mode\nPostprandial acid pocket and the alginate raft\nFailed acid clearance: supine, saliva loss, weak swallow\nObesity, visceral pressure, and Barrett risk\nLA-grade erosive esophagitis and its consequences\n \n \nKey decisions\n\nA resting sphincter under 10 mmHg is the exception, seen only in severe disease\nBaclofen stimulates GABA-B to cut transient LES relaxations and reduce reflux\nHiatal hernia over 3 cm mandates formal diaphragm repair plus laparoscopic fundoplication\nAlginate forms a raft that sinks the acid pocket, helping postprandial breakthrough even on a PPI\nLA grades C and D are unambiguous proof of reflux and require repeat endoscopy after healing to unmask Barrett's\nGastric bypass is reflux-friendly, sleeve gastrectomy worsens reflux and is the wrong bariatric choice\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline references: GERD and Refractory Reflux\nRead this episode: boardpearls.com/gi/episodes/gerd-and-refractory-reflux-ep1\nQuestions or feedback: hello@boardpearls.com.","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}