GERD

Question 1

GERD definition

Answer 1

troublesome clinical symptoms and/or complications associated with the passage of stomach contents into the esophagus that affect the patient’s QoL

Question 2

GERD complications

Answer 2

reflux esophagitis, hemorrhage, stricture, and Barrett esophagus

Question 3

Nonerosive GERD definition

Answer 3

presence of typical symptoms of GERD without any erosive lesions within the esophagus

Question 4

GERD symptoms in infants <1 year

Answer 4

Regurgitation, vomiting, arching, irritability, poor weight gain, crying

Question 5

GERD symptoms in children 1-5

Answer 5

Regurgitation, abdominal pain, cough

Question 6

GERD symptoms in children >6 years

Answer 6

Heartburn, epigastric pain, dysphagia

Question 7

Most common extraesophageal symptoms in children

Answer 7

Apnea, coughing, wheezing –> manifest as asthma, pneumonia, nocturnal cough, sinusitis, laryngitis, otitis media, dental erosions

Question 8

Initial diagnosis of GERD is based on what?

Answer 8

Clinical presentation of the patient with typical signs or symptoms for reflux

Question 9

Procedures for GERD diagnosis

Answer 9

upper GI endoscopy, barium contrast radiography

Question 10

Trial of acid suppression for GERD in infants and young children as a diagnostic test

Answer 10

DON’T DO IT! Older kids can have a 2-4 week trial

Question 11

GERD patho

Answer 11

Transient lower esophageal sphincter relaxations (TLESRs), decreased LES pressure, delayed gastric emptying, hiatal hernia

Question 12

Factors that can contribute to reduced LES pressure

Answer 12

tobacco smoke exposure, intake of fatty foods, certain medications (theophylline, CCBs), gastric distention

Question 13

Other GERD risk factors

Answer 13

Bottle-fed infants, genetics (locus on chromosome 13), neurologic impairment, obesity, esophageal atresia, chronic lung disease, prematurity

Question 14

Non-pharm treatment for GERD

Answer 14

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

Question 15

GERD pharmacologic treatment: H2RA advantages

Answer 15

quick onset, data available in peds, cost-effective, don’t need to taper upon D/C, liquid formulations available

Question 16

H2RA disadvantages

Answer 16

Tolerance develops when used more often

Question 17

H2RA place in GERD treatment

Answer 17

PRN, first-line maintenance for mild GERD

Question 18

PPI advantages

Answer 18

Most potent, inhibits meal-induced acid secretions, heals esophagitis more than H2RAs

Question 19

PPI disadvantages

Answer 19

Limited liquid formulations, CYP genetic polymorphisms, adverse effects, cost, increased risk of infections, rebound

Question 20

PPI place in therapy

Answer 20

1st-line maintenance in mod-severe GERD
1st-line for erosive esophagitis

Question 21

Prokinetic agent disadvantages

Answer 21

ADESs
Lower efficacy than PPIs and H2RAs
Limited data
Don’t suppress acid

Question 22

Prokinetic agents place in therapy

Answer 22

Routine use not recommended, may be useful in patients with delayed gastric emptying

Question 23

Antacids advantages

Answer 23

Quick onset
Variety of dosage forms
Low risk of ADEs

Question 24

Antacid disadvantages

Answer 24

Require frequent administration
Lower efficacy than PPIs and H2RAs

Question 25

Antacid place in therapy

Answer 25

PRN in older children

Question 26

Sucralfate advantages

Answer 26

Coat may heal mucosa
Low risk of ADEs

Question 27

Sucralfate disadvantages

Answer 27

Limited data
Not monotherapy for GERD

Question 28

Sucralfate place in therapy

Answer 28

Adjunct to H2RA, PPI in erosive esophagitis

Question 29

PPIs and PK data in kids ages 1-10

Answer 29

Higher mg/kg/dose because of high 2C19 activity

Question 30

Duration of PPI treatment

Answer 30

12 weeks, taper off over 4 weeks when done