GERD

Question 1

Types of GERD

Answer 1

Erosive GERD
Non-erosive GERD

Question 2

Complications of GERD

Answer 2

Esophagitis
Ulceration
Strictures
Adenocarcinoma

Question 3

Causes of GERD

Answer 3

Obesity
Hiatus hernia
Increased intra-abdominal pressure e.g. in pregnancy
Long term use of nasogastric tube
Agents that decrease lower oesophageal sphincter pressure
Children with chronic neurological disease (e.g. cerebral palsy

Question 4

Agents that decrease lower esophageal sphincter pressure

Answer 4

Alcohol
Cigarettes
Anticholinergics (Hyoscine butylbromide, Propantheline bromide)
Morphine
Diazepam
Pethidine
Calcium channel blockers

Question 5

Symptoms of GERD

Answer 5

Heartburn
Dyspepsia
Early satiety
Retrosternal epigastric pain
Pain on swallowing
Difficulty swallowing
Nocturnal regurgitation
Asthma-like (may be worse at night)

Question 6

Describe the nature of the heartburns in GERD

Answer 6

Worsens with vigorous exercise, bending forward, lying
Relieved by antacids and sitting upright

Question 7

Describe the nature of the epigastric pain in GERD

Answer 7

Mimics angina pectoris by radiating to neck, jaws and arms
The pain is worse on bending down e.g. sweeping

Question 8

Symptoms of GERD in children

Answer 8

Failure to thrive/refusing food
Vomiting
Coughing
Forceful regurgitation which may lead to aspiration pneumonia
Iron deficiency anaemia
Wheezing

Question 9

Investigations in GERD

Answer 9

Oesophago-gastro-duodenoscopy (OGD) (upper gastro-intestinal tract endoscopy)
Chest X-ray to exclude other causes
Abdominal ultrasound (to exclude other diseases)
Barium swallow with fluoroscopy (especially useful in children)
Oesophageal pH monitoring (in cases that are difficult to diagnose)
Lower oesophageal sphincter manometry (in cases that are difficult to diagnose)

Question 10

Lifestyle changes in GERD

Answer 10

Elevate head of bed by about 30 degrees or sleep on pillows
Avoid sleeping within 3 hours after eating
Avoid over-eating and heavy meals before bedtime
Avoid foods that aggravate symptoms e.g. fatty and spicy food
Avoid smoking and alcohol
Avoid Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Encourage moderate exercise
Weight reduction in overweight and obese individuals
Avoid corsets, instead wear loose clothing
Surgical treatment

Question 11

Fundoplication

Answer 11

Surgical treatment for severe GERD, treatment failure and complications in GERD
The fundus is folded and sewn around the lower esophageal sphincter

Question 12

Treatment for non-erosive GERD

Answer 12

Magnesium trisilicate, oral, 15 ml 8 hourly
Or
Antacids containing Aluminum hydroxide, Magnesium hydroxide, Simethicone, Calcium alginates
Or
Omeprazole, oral,
Adults
20 mg daily for 4-8 weeks
Children
> 20 kg; 20 mg daily for 4-8 weeks
10-20 kg; 10 mg daily for 4-8 weeks
5-10 kg; 5 mg daily for 4-8 weeks
Or
Esomeprazole, oral,
Adults
40 mg daily for 4 to 8 weeks
Or
Rabeprazole, oral,
Adults
20 mg daily for 4 to 8 weeks

Question 13

Treatment for severe or erosive GERD

Answer 13

Omeprazole, oral,
Adults
20 - 40 mg daily for 8 weeks
Children
> 20 kg; 20 mg daily for 4-8 weeks
10-20 kg; 10 mg daily for 4-8 weeks
5-10 kg; 5 mg daily for 4-8 weeks
Or
Esomeprazole, oral,
Adults
40 mg daily for 8 weeks
Or
Rabeprazole, oral,
Adults
20-40 mg daily for 8 weeks