Source / episode info

• **Episode:**213
• **Title:**Divine Intervention Episode 213 – Family Medicine Shelf Review Series 4 (GI).
• **Published:**2020-02-26
• Source:Episode page

One-liner

This episode provides a comprehensive review of GI pathology algorithms, covering the workup of dysphagia and esophageal motility disorders (Achalasia, EoE), screening guidelines for Barrett's esophagus, management of PUD/GERD, and diagnostic criteria for acute pancreatitis.

High-yield summary

• Dysphagia Workup: If alarm symptoms are present (dysphagia, weight loss, painful swallowing, age >50), perform an EGD. For suspected oropharyngeal dysphagia, start with a Video Fluoroscopy/Barium Swallow to differentiate the cause.
• Achalasia Algorithm: The diagnostic sequence is crucial: 1. Barium swallow (look for "bird's beak" pattern) -> 2. Esophageal Manometry -> 3. EGD. Never perform EGD first.
• Barrett's Screening: High risk criteria include male sex, age >50 years, and chronic GERD symptoms lasting >5 years. Screen with EGD/biopsy.
• Pancreatitis Diagnosis: Requires 2 of the following: Severe epigastric pain radiating to the back; Elevated lipase (>3x ULN); Characteristic CT findings.
• PUD Management Pearls: Always test for H. pylori in any patient with PUD symptoms, regardless of NSAID use. Chronic steroid users require prophylactic PPIs and bisphosphonates.

Learning objectives

• Differentiate the appropriate diagnostic workup for dysphagia based on location and associated symptoms.
• Apply high-risk criteria to determine when EGD is mandatory in GERD/dysphagia.
• Understand the pathophysiology, diagnosis, and management of esophageal motility disorders (Achalasia, EoE).
• Recognize the clinical signs and diagnostic criteria for acute pancreatitis and its complications.
• Master the prophylactic medication regimen required for patients on chronic systemic steroids.

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