gerd

Question 1

Non-Pharmacological Treatment

Answer 1

• Avoid eating large meals
• Avoid eating within 3 hours of bedtime
• Avoiding foods or medications that exacerbate GERD
• Stop or decrease smoking
• Avoid alcohol
• Lose weight: studies found that reduction in BMI by 3.5 u improves GERD symptoms and decreases need for GERD-related medications.
• Elevate the head of bed 6–8 inches: decreases nocturnal esophageal acid contact time
• Sleep in the left lateral decubitus position

Question 2

Clinical Presentation & Diagnosis

Answer 2

The most useful tool in the diagnosis of GERD is the clinical history, including both presenting symptoms and risk factors.
Other diagnostic tests may include endoscopy, ambulatory esophageal reflux monitoring, and manometry.
Endoscopy is preferred for assessing mucosal injury and to identify complications (a mucosal biopsy is taken to confirm this)

Question 3

typical and atypical symtoms testing

Answer 3

Patients presenting with uncomplicated, typical symptoms of disease should not receive invasive testing.
These patients generally benefit from a trial of patient-specific lifestyle modifications and empiric acid-suppressing therapy.

Endoscopy should also be performed in patients with atypical symptoms

Question 4

Typical Symptoms

Answer 4

heartburn and acid regurgitation.
Other typical symptoms: early satiety, belching, hiccups, nausea & vomiting.

Question 5

Atypical Symptoms

Answer 5

heart (e.g. Chest pain), lungs (e.g. Chronic cough & asthma) & ENT (e.g. Laryngitis, Pharyngitis & Hoarseness) .

Question 6

Complicated symtoms

Answer 6

esophageal erosions or strictures, Barrett metaplasia, and adenocarcinoma of the esophagus.
Worrisome symptoms of GERD: dysphagia, odynophagia, vomiting of blood, bloody or tarry stools, unexplained weight loss, or anemia.

Question 7

“Step-down

Answer 7

starting with maximal therapy, such as therapeutic doses of PPIs, is always appropriate as a first-line strategy in patients with documented esophageal erosion.

Question 8

Step-down adv and dis

Answer 8

Advantages: Rapid symptom relief, avoidance of over-investigation.
Disadvantages: Potential overtreatment, higher cost, increased potential adverse effects.

Question 9

Step-up

Answer 9

starting with lower-dose over-the-counter (OTC) products for patients with less severe symptoms without evidence of esophageal erosion.
Advantages: Avoids overtreatment, lower initial cost.
Disadvantages: Potential undertreatment, partial symptom relief, taking longer for symptom control, may lead to over-investigation.