GERD

Question 1

Signs and symptoms of GERD

Answer 1

HEARTBURN!

Substernal burning, chest pain, regurgitation of stomach contents

Question 2

Diagnosis of GERD

Answer 2

Heartburn for an extended period (3 months)
Tried OTC products but symptoms came back
Can also use endoscopy to see possible esophagitis and Barrett’s esophagus

Question 3

Complications of GERD

Answer 3

If left untreated, can lead to esophagitis, Barrett’s esophagus, or esophageal cancer

Question 4

Non-pharm treatment of GERD

Answer 4

Small frequent meals, remain upright after/during eating, don’t eat at least 3 hours before bed, avoid trigger foods, weight loss, smoking cessation, prop head of bed with foam wedge, avoid tight-fitting clothing

Question 5

GERD treatment goals

Answer 5

Relieve symptoms, heal any damaged mucosal tissue, prevent complications

Question 6

Antacids for GERD

Answer 6

Tums, Rolaids

Question 7

ADEs of antacids

Answer 7

Mg-containing salts may cause diarrhea
Al and Ca-containing salts may cause constipation
Overall well tolerated

Question 8

H2RAs for GERD

Answer 8

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)

Question 9

OTC dosing for H2RAs is ? of the Rx dose.

Answer 9

Half of the Rx dose

Question 10

What can develop with long-term H2RA use?

Answer 10

Tolerance

Question 11

Dosing frequency of H2RAs

Answer 11

BID

Question 12

Which drug class has the most potent acid suppression for GERD?

Answer 12

PPIs

Question 13

PPI drugs

Answer 13

Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Esomeprazole (Nexium)

Question 14

PPI counseling point about when to take it

Answer 14

Dosed once daily in the morning (take before first meal of the day)

Question 15

OTC duration of PPI therapy

Answer 15

14 days

Question 16

Rx duration of PPI therapy

Answer 16

8 weeks

Question 17

PPI side effects

Answer 17

Increased risk of C. diff infection, CAP, thrombocytopenia, CNS effects, osteoporosis and increased fracture risk with long-term use

Question 18

When to use PPI chronically

Answer 18

Complications (esophagitis, Barrett’s)
NSAID use in NSAID-induced PUD
Symptoms return when stopping PPI

Question 19

How to manage chronic PPI use

Answer 19

Titrate to lowest effective dose to prevent ADEs, maybe intermittent treatment, PRN dosing, OTC strength

Question 20

Alternate therapy for chronic PPI use

Answer 20

Can also use an H2RA PRN or antacids for episodic relief

Question 21

Dyspepsia signs and symptoms

Answer 21

Discomfort in the epigastrum (bra line), burning, fullness, gnawing, bloating, early satiety

Question 22

Is dyspepsia always associated with GERD?

Answer 22

Sometimes, but sometimes not