GERD Flashcards
NSAIDS
- inhibit function of
- cause gastric ulcers
- inhibit function of prostaglandin PGE2
GERD Alarming Symptoms
- dysphagia
- odynophagia (painful swallowing)
- bleeding
- weight loss
- anemia
- long duration
- no response to treatment
Patient-directed Therapy
- OTC Antacids
- OTC H2 Receptor Antagonists
- OTC PPI
Antacids
- react with gastric HCl to form salt and water
- keep pH >4.0
- if CO3 = gas
- if OH = no gas
- Mg2+ = diarrhea
- Al3+ = constipation
Gastric Antisecretory Drugs
- inhibit activities of histamine, acetylcholine, and the proton pump
Gastric Secretory Pathway
- ECL cells -> histamine
- histamine binds H2 receptor on parietal cells -> activates H|K ATPase
- – also activated by gastrin and acetylcholine
3 principle agents for gastric acid secretion
- histamine
- acetylcholine
- gastrin
H2 Histamine Receptor Blockers
- analog of histamine
- inhibit binding of histamine to H2 histamine receptor on parietal cells -> decreases acid production
- eliminates symptoms in up to 50% of patients
Cimetidine
H2 Blocker
- first commercial H2 receptor antagonist
- CNS side effects
- – access to CNS, dizziness, drowsiness
- breast development in males (gynecomastia)
Ranitidine
H2 Blocker
- 10x more active than Cimetidine
- no CNS side effects, no Gynecomastia
Famotidine
H2 Blocker
(aka pepcid)
- his suggestion
- 30x more active than cimetidine
PPIs
- provide complete endoscopic mucosal healing of esophagitis at 6-8 weeks in 75%-100% of cases
- more expensive than H2 blockers
- exist in inactive form (prodrug)
- – becomes active when interacts with acid
- – bind irreversibly (covalently) to H|K ATPase, the terminal source of acid in parietal cells
- much slower*
What NOT to use with PPI
antacid: decrease in H+ will make PPI never active
Nizatidine
H2 Antagonist
H2 Antagonists ending
end in -TIDINE
Omeprazole
PPI
Lansoprazole
PPI
Rabeprazole
PPI
Pantoprazole
PPI
Esomeprazole
PPI
PPI ending
end in -PRAZOLE
Promotility Therapy
- corrects defects that can lead to GERD
- still in research
Surgery
Indications, Paradox, Complications
Indications: recurrent symptoms, BE
Paradox: success greatest in patients <50y/o and with typical symptoms that resolve with PPIs
Complications: Obstructive symptoms; disruption of vagally-mediated relaxation of the LES with swallowing
Endoscopic Therapy
- RF application to the LES
- Endoscopic sewing
- injection of non-reabsorbable polymer into LES region
PPIs REQUIRE
acid environment to work; don’t take with antacids or H2R antagonists
6 Treatment Modalities
- lifestyle modification
- patient directed therapy
- acid suppression
- promotility (prokinetic) therapy
- endoscopic surgery
- surgery
