GERD

Question 1

What are the characteristics of physiologic reflux?

Answer 1

• Occurs after eating
• Short-lived
• Rarely occurs during sleep

Question 2

What are the characteristics of pathologic reflux?

Answer 2

• Associated with symptoms (not including those typical of GERD)
• Associated with mucosal injury
• Nocturnal symptoms (~ 70%)

Question 3

Describe the three mechanisms of GERD.

Answer 3

1. Reduction in tone of lower esophageal sphincter
2. Irritation of esophageal mucosa
3. Increased gastric acid secretion

Question 4

What pH levels can the esophagus tolerate? Stomach?

Answer 4

Esophagus: pH 3.- 5
Stomach: pH 1 - 3

Question 5

What are the symptoms typical of GERD?

Answer 5

• Heartburn
• Pyrosis (heartburn)
• Regurgitation

Question 6

What is the definition of regurgitation?

Answer 6

Sensation of movement of gastric contents into the mouth or hypopharynx

Question 7

What medication is the standard of care treatment for GERD?

Answer 7

PPIs (Proton Pump Inhibitors)

Question 8

What features in a GERD patient should cause alarm?

Answer 8

• New onset at age 60+ years
• Evidence of GI bleeding or IDA
• Anorexia or weight loss
• Dysphagia
• Vomiting
• GI cancer in a 1st degree relative

Question 9

List risk factors for Barrett’s Esophagus.

Answer 9

• Duration of GERD > 5 - 10 years
• Age > 50 years
• White race
• Male
• Hiatal hernia
• Obesity
• Tobacco use
• Nocturnal reflux

Question 10

What is the mechanism of action of antacids? Give examples of antacid medications.

Answer 10

Mechanism:
- Increases pH for about 20 - 30 minutes
- Fastest relief
- PRN (as needed) treatment

Examples:
- Maalox
- Mylanta
- Rolaids
- Tums

Question 11

What is the mechanism of action of H2 receptor antagonists? Give examples of H2 receptor antagonist medications.

Answer 11

Mechanism:
- Decreases acid production by parietal cells
for 6 - 12 hours
- Provides relief in about 60 minutes
- Taken PRN (as needed)

Examples:
- Cimetidine (Tagamet)
- Ranitidine (Zantac)
- Famotidine (Pepcid)
- Nizatidine (Acid)

Question 12

What is the mechanism of action of proton pump inhibitors? Give examples of proton pump inhibitor medications.

Answer 12

Mechanism:
- Reduces gastric acid secretion
- Provides relief in 1 - 3 days
- Rx for 4 - 8 weeks

Examples:
- Omeprazole (Prilosec)
- Lansoprazole (Prevacid)
- Rabeprazole (Aciphex)
- Esomeprazole (Nexium)
- Pantoprazole (Protonix)