Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

Tag: EGD

Endoscopy Simulator

Thought I’d share a photo of my residency program’s GI endoscopy simulator!  Earlier today, I had fun testing out some of the EGD and Colonoscopy scenarios on this machine.  Once a month, our program allows for “Simulation (sim) Lab.”  Essentially, it’s an hour-long block wherein residents practice code blue 90’s, rapid responses, central line insertions, and even practice with the simulator.

Interestingly, not only does this simulator attempt to recreate life-like images while you manipulate the endoscope, but it also includes a fully-functional biopsy/intervention channel.  This allows the user to position biopsy forceps, epinephrine injection needles, and more.  Really cool technology!

GI endoscopy simulator

Simulator is ready-to-go for the next clinical scenario!

Gastroesophageal Reflux Disease (GERD)

GERD is incredibly common, with an estimated prevalence of 10-20% in the Western hemisphere.  It’s important to note that GERD has many overlap symptoms with cardiac chest pain, thus cardiovascular causes should be ruled out first before the diagnosis of GERD.



  • Clinically
    • Insomnia/poor sleep quality, diminished work output
    • Typical heartburn, liquid regurgitation with resultant metallic or acidic quality
    • Alarm symptoms:  dysphagia (r/o malignancy, ring, web), weight loss, bloody vomitus, and black tarry stools).
      • Upper endoscopy is generally a preferred modality in these cases
    • Pregnancy-induced GERD is common
    • Risk factors:  obesity, “trigger” foods (caffeine, spices, oranges/grape fruit, alcohol, foods high in fat)
    • GERD can lead to:
      • erosive esophagitis, Barrett metaplasia, cancer, and stricture.
  • Diagnosis of GERD
    • Clinical history, response to PPI, and pH testing.
    • If NO alarm symptoms, then response to empiric PPI will confirm dx.
    • If no response to empiric PPI, perform EGD.
    • If + alarm symptoms, first step is to perform EGD.
    • Ambulatory pH testing; Impedance pH exam can see acid and non-acid reflux.
  • Treatment
    • Lifestyle changes including diet/exercise.
    • Raise head of bed (pillows, incline) and stop nocturnal eating.
    • If a food leads to heartburn, eliminate it.
    • Best regimen:  PPI qdaily for 8 weeks
      • 30-60 minutes prior to first meal
      • OK for use in pregnancy
    • Alternative:  H2 blocker
    • Laparoscopic fundoplication or bariatric surgery only indicated when:
      • patient preference, side effects to meds, refractory GERD, and large hiatal hernia.
      • Will need pH-impedance testing, manometry to objectively identify GERD
      • May still need PPI 5-10 years down the road, despite therapeutic surgery.


  • ACP MKSAP 17:  Gastroenterology and Hepatology, pgs. 7-9
  • Image source:  https://en.wikipedia.org/wiki/Gastroesophageal_reflux_disease

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