GERD Flashcards
When LES pressure is low, it is ___ for stomach contents to flow back into the esophagus.
easier
this is bad
Which of the following mechanisms is known to cause or increase the risk of developing GERD?
A) faster gastric emptying
B) higher LES pressure
C) increase in esophageal mucosal resistance
D) acid pocket formation
acid pocket formation
extraesophageal symptoms
* ___ cough
* laryngitis
* wheezing
* ___
- chronic
- asthma
i
immediate medical attention
* dysphagia (difficulty ___ )
* odynophagia
* bleeding
* ___ % unexplained weight loss
automatic referal
- swallowing
- 5%
Rx therapy for GERD should last for ___ weeks
8
OTC therapy for GERD should last ___ weeks
2
diagnostic tests
upper ___ - preferred for assessing mucosal injury and complications
endoscopy
diagnostic tests
___ pH test (+ impedance) - useful for patietns not respodning to acid suppression after normal endoscopy
reflux
diagnostic tests
manometry (+/- impedance) - useful for patients who failed 2 trials of ___ with normal endoscopy findings to identify motor dysfunction
PPIs
looking for functions of the esophagus
diagnostic tests
___ radiography - lacks sensitivity + specificity; not routinely recommended
Barium
Complications of GERD
- ___ esophagitis
- Stricture ( ___)
- ___ esophagus
- ___ (cancer)
- erosive
- narrowing
- Barrett’s
- adenocarcinoma
prn medications for GERD
- antacids
- H2RAs
scheduled medications for GERD
- H2RAs
- PPIs
GERD treatment steps
- lifestyle modifications
- OTC treatments
- Rx treatment (___ weeks )
- If Rx fails, ___
- Surgery
- 8 weeks
- switch
REFER
- ___ symptoms
- OTC trial longer than ___ days with no relief
- alarm
- 14
Antacids
- ___ relief
- make intragastic pH > ___
- decrease activation of pepsinogen to ___
- increased ___ pressure
- immediate
- 4
- pepsin
- LES
T or F: only antacids increase LES pressure
True
antacids
caution in patients with ___ impairment taking ___ or ___ containing products
- renal
- calcium
- aluminum
Side effects of antacids
Calcium
* constipation
* ___ - alkali syndrome
Magnesium
* ___
* accumulation
Aluminium
* consitpation
* ___/neurotoxicity
- milk
- diarrhea
- confusion
Antacid Drug Interactions
affects ___ of :
* fluroquinolones
* tetracyclines
* azole antifungals
* levothyroxine
* Fe
* steroids
* digoxin
* HIV meds
* select oral antineoplastics
absorption
antacid drug interactions
take medications ___ hours before or ___ hours after antacids
- 2 hrs
- 4-6 hrs
single element containing antacids (2)
- Tums (calcium carbonate)
- Milk of Magnesia (magnesium hydroxide)
mixed antacids (4)
- Al + Mg: Maalox and Gaviscon (+ alginate acid)
- Al + Mg + simethicone: Mylanta, Maalox advanced max strength
- Ca + Mg: Rolaids, Mylanta Ultra
- Ca + simethicone: Alka-Seltzer heart burn + gas, Tums gas relief
Brand name
sodium bicarbonate + ASA + citric acid
Alka-Seltzer