Multimodality Imaging in Gastroesophageal Reflux Disease and its Complications

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.50
Procedures: 1.50
Abdomen and Pelvis: 1.50

Magnetic Resonance Imaging: 1.50
Procedures: 1.50
Body: 1.50

Nuclear Medicine Technology: 0.75
Procedures: 0.75
Endocrine and Oncology Procedures: 0.25
Gastrointestinal and Genitourinary Procedures: 0.50

Radiography: 2.00
Procedures: 2.00
Thorax and Abdomen Procedures: 2.00

Registered Radiologist Assistant: 2.75
Patient Care: 0.25
Pharmacology: 0.25
Procedures: 2.50
Abdominal Section: 2.50

Radiation Therapy: 0.50
Procedures: 0.50
Treatment Sites and Tumors: 0.50

Outline

1. Introduction
2. Normal Esophagus and Esophagogastric Junction
3. Gastroesophageal Reflux Disease
   1. Definition and Classification
   2. Clinical Manifestation
   3. Pathophysiology
   4. Diagnosis
   5. Treatment
4. Complications of GERD
   1. Reflux Esophagitis
      1. Definition and Pathophysiology
      2. Pathologic Features
      3. Imaging Features
      4. Treatment
   2. Peptic Stricture
      1. Definition and Pathophysiology
      2. Pathologic Features
      3. Imaging Features
      4. Treatment
   3. Barrett Esophagus
      1. Definition and Pathophysiology
      2. Pathologic Features
      3. Imaging Features
      4. Treatment
   4. Esophageal Adenocarcinoma
      1. Definition and Pathophysiology
      2. Pathologic Features
      3. Imaging Features
      4. Endoscopy
      5. Fluoroscopy
      6. Computed Tomography
      7. Positron Emission Tomography
      8. MR Imaging
      9. Treatment
5. Conclusion

Objectives

Upon completion of this course, students will:

1. state the estimated number of adults in the Western world that experience reflux symptoms
2. identify the epidemic that is believed to be responsible for the high prevalence of GERD in the United States
3. choose the primary imaging modality for the evaluation of the esophagus
4. list the factors that have resulted in barium studies being performed by fewer senior radiologists
5. describe how esophageal luminal distention with effervescents is beneficial
6. illustrate how the esophagus connects to the stomach
7. list the segments of the esophagus
8. choose the segment of the esophagus that is usually less than 3cm long
9. list the layers of the esophagus
10. state the junction that demarcates the transition from the esophagus to the stomach
11. describe how lower esophageal sphincter relaxation occurs
12. state the percent of GERD patients in the United States
13. list the characteristic symptoms of GERD
14. list the extraesophageal symptoms associated with GERD
15. describe the causes of lower esophageal sphincter failure
16. state the percent of GERD patients that have defective lower esophageal sphincters
17. state how high-resolution endoscopy provides exceptional mucosal detail
18. list the benefits of fluoroscopic esophagography
19. describe high-volume reflux
20. compare barium studies to endoscopy as related to accurately depicting hiatal hernias
21. list the imaging modalities that may help serve in the diagnosis of GERD
22. differentiate between nonpharmacologic and pharmacologic treatment for GERD
23. list the minimally invasive laparoscopic and endoscopic luminal treatments for GERD
24. state the earliest and most common manifestation of injury due to gastroesophageal reflux
25. describe regenerative changes associated with pathology of reflux esophagitis
26. describe how the severity of erosive reflux esophagitis is graded
27. state the most common cause of ulcers in the distal esophagus
28. recall the percent of patients that have had healing of erosive esophagitis based on a primary treatment algorithm
29. provide the alternate name for reflux-induced strictures
30. list the percent of GERD patients that have peptic ulcers
31. state the sensitivity of biphasic esophagography in the detection of peptic stricture
32. describe intramural pseudodiverticulosis
33. list treatment options for refractory strictures
34. state the most important determinant for the development of Barrett’s esophagus
35. describe long-segment Barrett’s esophagus
36. state the classic finding for Barrett’s esophagus at esophagography
37. recall the worldwide percentage of esophageal cancer
38. state the role of multimodality imaging in the detection of esophageal adenocarcinoma
39. describe the process of esophageal adenocarcinoma tumor staging
40. state the percent of patients with esophageal adenocarcinoma that experience lymphadenopathy