Gastroesophageal Reflux Disease & Peptic Ulcer Disease

Question 1

Key drugs that can worsen GERD symptoms

Answer 1

Aspirin/NSAIDs
Bisphosphonates
Dabigatran
Estrogen products
Fish oil products
Iron supplements
Nicotine replacement therapy
Steroids
Tetracyclines

Question 2

Lifestyle modifications for GERD

Answer 2

Weight loss
Elevate head of the bed with foam wedges or blocks
Avoid eating high fat meals 2-3 hours before bedtime
Avoid food/beverages that can trigger reflux

Question 3

Initial drug treatment for GERD

Answer 3

PPI once daily for 8 weeks
Can increase to BID if partial response or if nocturnal symptoms are present

Question 4

Maintenance treatment for GERD

Answer 4

1st line: PPI at the lowest effective dose
Alternative: H2RA, if there is no erosive esophagitis and it relieves symptoms
Not recommended: metoclopramide or sucralfate