10: Adult GERD Flashcards
GERD pharm treatment.
- Episodic: Antacids 1 hour before meals and bedtime
- Persistent: Add H2 Blocker or PPI
- With mildly erosive, H2 Blocker often sufficient.
- In severe cases, PPI always indicated.
- Prokinetic drugs limited.
What will endoscopy rule in/out?
- Esophageal strictures
- Barrett’s esophagus (precancerous)
- Delayed esophageal or gastric emptying
3 major mechanisms of GERD.
- Transient lower esophageal sphincter (LES) relaxation
- Abdominal strain
- Low resting LES
7 lifestyle modifications for GERD.
- Smoking cessation
- Weight loss
- Smaller, lower fat meals
- Walking after meals
- Decreased caffeine, trigger foods
- Avoid eating within 3 hours of bedtime
- Elevate HOB 6-8”
What classification for erosive esophagitis (A, B, C, D)?
Mucosal breaks continuous between tops of 2 or more mucosal folds.
Grade C
H2 blockers are pregnancy category _____.
H2 blockers are pregnancy category B.
What factors affect LES?
- Dietary:
- Caffeine
- Smoking
- ETOH
- Chocolate
- Peppermint
- Meds:
- Tricyclic Antidepressants
- Diazepam
- CCBs
What classification for erosive esophagitis (A, B, C, D)?
Mucosal breaks >75% of the esophageal circumference.
Grade D
What are side effects of PPIs?
- Other GI disturbance
- Possible LFT elevation
- Arthralgias
PPIs are pregnancy category _____.
PPIs are pregnancy category B.
Long-term use (>12 months) of _____ can cause B12, magnesium, and zinc deficiencies. It is also potentially linked to arrhythmias and increased fracture risk.
Long-term use (>12 months) of PPIs can cause B12, magnesium, and zinc deficiencies. It is also potentially linked to arrhythmias and increased fracture risk.
What are side effects of H2 blockers?
- Other GI disturbance
- Rash (rare)
- Thrombocytopenia
- Hepatotoxicity
- Pneumonia
How often are H2 blockers dosed?
BID
What is the pathology of GERD?
Gastric contents are regurgitated into the esophagus leading to irritation and injury to the esophageal mucosa.
How often are PPIs dosed?
QD-BID, but don’t initiate at BID.
