GERD Flashcards
GERD definition
troublesome clinical symptoms and/or complications associated with the passage of stomach contents into the esophagus that affect the patient’s QoL
GERD complications
reflux esophagitis, hemorrhage, stricture, and Barrett esophagus
Nonerosive GERD definition
presence of typical symptoms of GERD without any erosive lesions within the esophagus
GERD symptoms in infants <1 year
Regurgitation, vomiting, arching, irritability, poor weight gain, crying
GERD symptoms in children 1-5
Regurgitation, abdominal pain, cough
GERD symptoms in children >6 years
Heartburn, epigastric pain, dysphagia
Most common extraesophageal symptoms in children
Apnea, coughing, wheezing –> manifest as asthma, pneumonia, nocturnal cough, sinusitis, laryngitis, otitis media, dental erosions
Initial diagnosis of GERD is based on what?
Clinical presentation of the patient with typical signs or symptoms for reflux
Procedures for GERD diagnosis
upper GI endoscopy, barium contrast radiography
Trial of acid suppression for GERD in infants and young children as a diagnostic test
DON’T DO IT! Older kids can have a 2-4 week trial
GERD patho
Transient lower esophageal sphincter relaxations (TLESRs), decreased LES pressure, delayed gastric emptying, hiatal hernia
Factors that can contribute to reduced LES pressure
tobacco smoke exposure, intake of fatty foods, certain medications (theophylline, CCBs), gastric distention
Other GERD risk factors
Bottle-fed infants, genetics (locus on chromosome 13), neurologic impairment, obesity, esophageal atresia, chronic lung disease, prematurity
Non-pharm treatment for GERD
Lifestyle modifications, anti reflux therapy, surgery in select patients where medical therapy fails, life-threatening complications, and patients with a requirement for long-term medical therapy
GERD pharmacologic treatment: H2RA advantages
quick onset, data available in peds, cost-effective, don’t need to taper upon D/C, liquid formulations available
H2RA disadvantages
Tolerance develops when used more often
H2RA place in GERD treatment
PRN, first-line maintenance for mild GERD
PPI advantages
Most potent, inhibits meal-induced acid secretions, heals esophagitis more than H2RAs
PPI disadvantages
Limited liquid formulations, CYP genetic polymorphisms, adverse effects, cost, increased risk of infections, rebound
PPI place in therapy
1st-line maintenance in mod-severe GERD
1st-line for erosive esophagitis
Prokinetic agent disadvantages
ADESs
Lower efficacy than PPIs and H2RAs
Limited data
Don’t suppress acid
Prokinetic agents place in therapy
Routine use not recommended, may be useful in patients with delayed gastric emptying
Antacids advantages
Quick onset
Variety of dosage forms
Low risk of ADEs
Antacid disadvantages
Require frequent administration
Lower efficacy than PPIs and H2RAs
Antacid place in therapy
PRN in older children
Sucralfate advantages
Coat may heal mucosa
Low risk of ADEs
Sucralfate disadvantages
Limited data
Not monotherapy for GERD
Sucralfate place in therapy
Adjunct to H2RA, PPI in erosive esophagitis
PPIs and PK data in kids ages 1-10
Higher mg/kg/dose because of high 2C19 activity
Duration of PPI treatment
12 weeks, taper off over 4 weeks when done
