E1: GERD Flashcards
What are the possible complications of GERD?
- Barretts esophagus
- Erosive esophagitis
- Strictures
- esophageal cancer
What is it called when the lower esophageal sphincter is relaxed, allowing backflow of stomach contents?
GERD
What are the extraesophageal manifestations of GERD?
- Bronchospasm/wheezing
- Larngitis
- chronic cough
- loss of dental enamel
What medications decrease the LES pressure?
Anticholinergics, TCAs, CCBs, nitrates, and narcotics
What drugs can injure the GI mucosa?
-Bisphosphonates, Iron supplements, NSAIDs, potassium, tetracycline
What is the most common type of Hiatal hernia?
Sliding hernia
What will you see on CXR of a patient with a hiatal hernia?
A retro cardiac mass with or without an air fluid level
What is the best diagnostic study to evaluate mucosal injury?
EDG
What is the treatment of GERD?
- Lifestyle: Elevate head of bed, weight loss, selective elimination of triggering food
- Medication: Tums, PPIs, H2 blockers
- Anti-reflux surgery
What is the treatment of mild/intermittent GERD?
-Lifestyle modification, H2 blockers, and antacids
What is the treatment of GERD with severe symptoms?
-PPI daily x 8 weeks and lifestyle modification
How do H2 blockers treat GERD?
They block histamine at H2 receptors of gastric parietal cells, which leads to decreased secretion of stomach acid
How do PPIs treat GERD?
They reduce the amount of acid being produced by glands in the stomach
-take 30 minutes before the first meal of the day
What are the possible complications of long term PPI use?
- Risk of infection (acidic environment is protective)
- Malabsorption: Mg, B12, calcium, iron
- *Check Mg periodically
How long should a patient with GERD be on medication if they do not have severe erosive esophagitis and Barrett’s esophagus?
-They should have the lowest dose and shortest duration appropriate and discharge meds completely in patients without symptoms