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GERD Flashcards

1
Q

What are the 2 classifications of GERD?

A

NERD
ERD

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2
Q

What is the presence of GERD symptoms without erosions on endoscopic exam?

A

NERD (non-erosive reflux disease)

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3
Q

What is the presence of GERD symptoms with erosions present

A

ERD (erosive reflux disease)

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4
Q

What is GERD?

A

chronic symptoms or mucosal damage due to abnormal reflux of gastric contents into the esophagus

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5
Q

What is the most frequently reported symptom of GERD?

A

heartburn

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6
Q

Which patient populations are most likely to get GERD?

A
  1. > 40 y/o
  2. ~50% of pregnant women
  3. infants
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7
Q

What are risk factors for GERD?

A
  1. genetics
  2. obesity
  3. alcohol use beyond moderation
  4. smoking
  5. excess caffeine
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8
Q

What are the key factors in development of GERD?

A
  1. decrease in lower esophagal sphincter pressure/ tone
  2. decreased clearance of gastric contents from esophagus
  3. decrease mucosal resistance
  4. decreased gastric emptying
  5. pH < 4 of gastric fluid
  6. anatomic features (hiatal hernia)
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9
Q

Why does a hiatal hernia increase GERD incidence?

A

large opening for gastric contents to move through

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10
Q

What are typical symptoms of GERD?

A
  1. heart burn >/= 2 times/ week on regular basis
  2. regurgitation
  3. belching
  4. hypersalivation
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11
Q

What are extraesophageal (atypical) symptoms?

A
  1. chronic cough
  2. asthma like symptoms
  3. laryngitis/ hoarseness
  4. recurrent sore throat
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12
Q

What are complicated symptoms that need refered on?

A
  1. Dysphagia (trouble swallowing)
  2. Odynophagia (painful swallowing)
  3. bleeding
  4. weight loss
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13
Q

What are aggravating factors?

A
  1. laying down (recumbency)
  2. increased intraabdominal pressure
  3. decreased gastric motility
  4. decreased LES tone
  5. foods and medications that decrease LES tone
  6. direct mucosal irritation
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14
Q

What medications decrease LES tone?

A

Anticholinergics
Benzos
Caffeine
Dihydropyridine CCBs
Estrogen
Alcohol
Nicotine

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15
Q

What medications are direct irritants to the esophagus?

A

Oral bisphosphonates
ASA
Iron
NSAIDs
Potassium

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16
Q

What are complications of GERD?

A

Erosions
Ulcerations
Strictures
Barrett’s esophagus
Adenocarcinoma

17
Q

Why must those with Barrett’s esophagus be monitored every few years for adenocarcinoma?

A

40- fold increased risk of developing adenocarcinoma

18
Q

How is GERD diagnosed?

A

presence of symptoms

19
Q

What is an endoscopy required for?

A

identifying complications of GERD

20
Q

What are the agents used to treat GERD?

A
  1. PPIs
  2. H2RA
  3. antacid/ alginic acid
21
Q

Why are PPIs preferred for treatment?

A

significantly faster esophageal healing

22
Q

When should PPIs be administered?

A

30-60 minutes before meals

23
Q

What are things to look out for when using PPIs?

A
  1. C. difficile- associated diarrhea
  2. osteoporosis related fractures
  3. hypomagnesemia
24
Q

Which 2 PPIs should not be administered with Clopidogrel due to CYP2C9 inhibition?

A

Omeprazole
Esomeprazole

25
Q

What are adverse effects with PPIs?

A

Headache
N/D

26
Q

Which H2RA is associated with gynocomastia?

A

Cimetidine

27
Q

What are adverse effects with H2RAs?

A

Headache
Constipation
Diarrhea

28
Q

What is the treatment of intermittents, mild heart burn?

A

Lifestyle modification + Antacid (Maalox, Mylanta)
+/- OTC H2RAs or OTC PPI

29
Q

What is the treatment of GERD?

A

Lifestyle modification + PPI QD-BID x 8 weeks
+/- maintenance therapy if symptoms return

30
Q

What is utilized for GERD maintenance therapy?

A

PPI @ lowest effective dose
H2RA (if no erosive esophagitis or Barret’s)

31
Q

What is the treatment of erosive esophagitis/ severe sx/ complications?

A

Lifestyle modifications + Rx PPI QD-BID x 8 weeks

32
Q

What are lifestyle modifications?

A
  1. weight loss
  2. elevate head 6-8 inches
  3. smaller, more frequent meals
  4. do not eat 3 hours prior to sleep
  5. avoid aggravating foods
  6. avoid alcohol/ tobacco
33
Q

What is used for maintenance therapy for those with NERD/ uncomplicated GERD?

A

intermittent PPI or H2RA

34
Q

What is used for maintenance therapy for complicated GERD?

A

long-term PPI maintenance treatment at lowest effective dose

35
Q

What are risks with long term PPI therapy?

A
  1. increase fracture risk
  2. increase infection risk (C.diff URTi)
  3. hypomagnesemia
  4. vitamin B12 deficiency
36
Q

What can be added to PPI therapy to decrease breakthrough symptoms overnight?

A

H2RA

37
Q

How do you taper a PPI in a patient with rebound acid secretion?

A

Taper over 4-6 weeks:
1. lower dose
2. extend interval QOD–> q 3rd day
3. use H2RAs and antacids on “off days”
Switch to H2RA with prn antacids then D/C

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