GERD Flashcards
Chronic symptoms or mucosal damage produced by abnormal reflux of gastric contents into the esophagus
GERD
Prolonged periods of inflammation of the esophagus can progress to what?
Erosion of the epithelium of the esophagus
What two things can GERD be further classified as?
- NERD
- ERD
What does NERD stand for?
Non-erosive Reflux disease
What does ERD stand for?
Erosive reflux disease
What is the most frequent clinical complaint of GERD?
Heartburn
What age does GERD most commonly occur?
Ages >40
True or False: Males experience GERD more than females
False (equal)
True or false: infants can experience GERD
True
What are 5 risk factors of GERD?
- Genetic
- Obesity
- Excessive alcohol use
- Smoking
- Excessive coffee intake
What does GERD decrease? 4
- LES pressure or tone
- Clearance of gastric contents
- Mucosal resistance
- Gastric emptying
What does GERD do to gastric fluid?
Makes it extra acidic
GERD can cause a _____ hernia
Hiatal
If a patient is experiencing heartburn for _____ on a regular basis it could be GERD
> or = 2x/week
What are 4 atypical symptoms of GERD?
- Chronic cough
- Asthma like symptoms
- Laryngitis/ hoarseness
- Recurrent sore throat
What are 4 alarm symptoms of GERD that you should refer on for?
- Dysphasia
- Odynophagia
- Bleeding
- Unexplained weight loss
Trouble swallowing
Dysphasia
Odynophagia
Painful swallowing
What may the alarm symptoms be indicative of?
Barretts esophagus
What are 5 aggravating factors of GERD?
- Recumbancy (lying down)
- Increased abdominal pressure
- Decrease in gastric motility
- Decreased LES
- Direct mucosal irritation
What foods can decrease LES pressure?
- Fatty foods
- Peppermint
- Spearmint
- Chocolate
- Coffee
What medications decrease LES pressure? 7
- Anticholinergics
- BZDs
- Caffeine
- DHP calcium channel blockers
- Estrogen
- Ethanol
- Nicotine
What 4 foods are direct irritants to the esophageal mucosa?
- Spicy food
- Orange juice
- Tomato juice
- Coffee
What 5 medications are direct irritants to the esophageal mucosa?
- Oral bisphosphonates
- Aspirin
- Iron
- NSAIDs
- Potassium
When normal squamous epithelium may convert to a columnar cell epithelium after long standing disease
Barrett’s esophagus
Those with Barrett’s esophagus can develop what?
Adenocarcinoma
When should patients be monitored for adenocarcinoma?
Every few years
What is heartburn also known as?
Pyrosis
When is invasive testing not indicated?
In uncomplicated GERD
Technique of choice to identify complication of GERD
Endoscopy
What is the mainstay of therapy for GERD?
PPIs
What are three agents primarily used to treat GERD?
- PPIs
- H2 antagonists
- Antacids or alginic products
Why are PPIs preferred over H2RAs?
PPIs have faster esophageal healing rates and faster, more complete heartburn relief
When should Omeprazole be taken?
30-60 minutes before a meal (usually breakfast)
What 3 PPIs can be taken without regard to meals?
- Dexlansoprazole
- Pantoprazole
- Rabeprazole
What are 4 warnings associated with the PPIs?
- C-diff
- Osteoporosis related fractures
- Hypomagnesia
- Vitamin b12 deficiency
What are the 6 PPIs?
- Omeprazole
- Pantoprazole
- Lansoprazole
- Dexlansoprazole
- Esomeprazole
- Rabeprazole
Which 2 PPIs may decrease the effectiveness of clopidogrel via CYP2C19?
- Omeprazole
- Esomeprazole
What are 3 H2RAs used to treat GERD?
- Famotidine
- Nizatidine
- Cimetidine
True or false: H2RAs can be used in pregnancy if indicated
True
Which PPIs are available in IV formulations?
- Pantoprazole
- Esomeprazole
What drug can cause gynecomastia?
Cimetidine
Why do the H2RAs become less effective over time?
Induce tachyphylaxis
What 3 drug classes can be used for intermittent, mild heartburn without GERD?
- Antacids
- OTC H2 antagonists
- OTC PPIs
What is the initial drug treatment for GERD?
PPI once daily for 8 weeks
When can you increase PPIs dose to twice daily?
If partial response is seen or nocturnal symptoms are present
If symptoms return, what can you use first line for maintenance therapy?
PPIs at lowest effective dose
What is the regimen for erosive esophagitis or severe symptoms and complications?
- Lifestyle modifications
- PPIs up to twice daily for 8 weeks
What are 7 lifestyle modifications?
- Weight loss
- Elevation of the head of the bed
- Eat smaller meals more frequently
- Avoid eating 3 hours prior to sleeping or lying down
- Avoid foods that aggravate GERD
- Avoid alcohol
- Tobacco cessation
What patients should receive maintenance therapy?
- Those w a symptomatic relapse of GERD following d/c of the drug
- Those with a history of complications (Barrett’s esophagus)
Adding a ____ at bedtime can control breakthrough symptoms at night.
H2RA
True or false: H2RAs need to be taken with meals in order to block acid secretion that is triggered by histamine
False
Why might it be hard for patients to stop taking PPIs?
Because of rebound acid secretion caused by the PPIs
When should you taper PPIs?
Over 4 to 6 weeks
How should you taper PPIs?
- Lower the dose
- Extend interval to QOD then every 3rd day
- Can give an antacid or H2RA for “off days”
What else can you suggest for rebound acid secretion?
Suggest switching to an H2RA and taking an antacid PRN for several weeks then d/c