GERD Flashcards
When does gastroesophageal reflux become GERF
When it impacts function
Symptoms of GERD in the pediatric population
•Refusal to feed
• frequent vomiting
• poor weight gain
• poor sleep
•Recurrent respiratory sx
•Irritability
Symptoms of GERD in older children
•Cough
•Asthma
• hoarseness
•dysphagia
• abdominal pain
• recurrent vomiting
Red flags for GERD in the pediatric population
- bilious vomiting
- gi bleed
- bulging fontanelles
-Fever - lethargy
- micro/macrocephaly
- seizures
- abdo tenderness
Pediatric pt with vomiting + weight loss. What Ix Will do you
CBC - WBC, hb
Lytes - na, k, Cl
Creatinine
Urinalysis
Celiac
Upper gi series ( if -indicated)
Rx of child with GERD
- Avoid overfeeding and tobacco smoke
- 2 wk trial of thickened feeds
- then 2.4wk trial of avoiding cows milk protein
- then ppl X 4-8 wk ( increased risk of resp and gi infections and # )
Symptoms of GERD in adults
Heartburn + acid reflux → presumptive diagnosis of GERD
ExtraesophageaI symptoms → chest pain, cough, globus sensation
Red flag sx of GERD in adults
Chest pain
Weight loss
Vomiting
Dysphagia
Gi blood loss
Anemia
Atypical sx of GERD when you should considera differential
Epigastric pain
Dyspepsia
Bloating
Belching
Nausea
Complications of GERD
Erosion, ulceration, hemorrhage, strictures,Barrett’s
Surveillance for Barretts and dysplasia
Barretts → routine surveillance
High grade dysplasia → repeat endoscopy in 3 months. Consider ablation in those not a candidate for surgery.
Extra esophageal complications of GERD,
Dental erosions
Laryngitis
Asthma
Aspiration pneumonia
Pulmonary fibrosis
Medications that decrease sphincter pressure
Anticholinagics
Progesterone
Estrogen
CCB
Theophylline
Caffeine
Nicotine
Opioids
Ethanol
Medications that are mucosal irritants
NSAID
Asa
Iron
Quinidine
Álendronate
Potassium citrate
Tetracycline
Clindamyún
Routine investigations done for GERD
Hemoglobin to rule out anemia
What are the indications of endoscopy in GERD
-Presence of alarm symptoms
-Failure of therapy X 4-8wks
-Continuing dysphagia after 2-4 wks of ppi
-To determine the severity of erosive esophagitis
-To detect Barretts
Management of GERD
- Lifestyle → weight loss, incline head of bed, avoid meals 2-3 3hr prior to sleeping.
-Mild GERD → alginates , antacids, low dose h2 receptor antagonist. Assess after 1 month - mod to severe GERD → ppi x 4-8 Wks once daily with reassessment. Taper/ discontinue if good response. If poor response try bid, increased dose or alternate ppi. If no response after 8-16 was refer for endoscopy
- surgical anti reflux therapy
What is mild GERD
<3 episodes/week, short , duration, low intensity
Management of moderate to severe GERD
Ppi for 4-8 weeks at low dose od (20mg) unless severe esophagitis (bid). If goodresponse attempt taper /discontinuation
Maintenance option→ H2antagonist ( non erosive disease)or on demand ppi therapy
Poor/inadequate response → double dose ppi or bid ppi a switch ppi. Reassess in 4 wks
Refer for endoscopy if no response to ppl after 8-16 wKs. Should be off meds x 2-4wks
When is longterm Rx with ppl indicated?
- Barrett
- grade c/d esophagitis
- erosive esophagitis
-esophageal stricture - eosinophilic esophagitis
- gastroprotection
- prevention of progression of idiopathic pulmonary fibrosis
- bleeding pud
Consider in those with hx of previous complicated vices, regular NSAID, concomitant SSRI/nsaid, 3 or more of age > 65, high dose NSAID, previous uncomplicated pup, concurrent asa/steroid /anticoagulant
Adjunctive therapy for GERD
Breakthrough symptoms → alginates
Nocturnal symptoms → H2 antagonists
Regurge/belching→baclofen
Gastroparesis → prokinetics
Risks of long term use of ppi
Hip fracture
C. difficult
Pneumonia
Deficiency of it B12, magnesium, iron
Hypoparathyroid
