GERD

Question 1

What is GERD

Answer 1

Reflux of gastric contents into the esophagus

Question 2

3 Classic Presentations of GERD

Answer 2

• Presumptive GERD
• Erosive Esophagitis
• Endoscopy Negative Reflux Disease

Question 3

Presumptive GERD

Answer 3

Patient presents with typical symptoms
- Treat empirically

Question 4

Erosive Esophagitis

Answer 4

Patients with GERD have acid/inflammation that damage the esophagus
- Seen with endoscopy

Question 5

Endoscopy Negative Reflux Disease

Answer 5

Majority of GERD patients, presents with GERD symptoms
- Normal esophagus on endoscopy

Question 6

Diagnosis of GERD

Answer 6

Frequency 2-3 weeks:
- Heartburn
- Regurgitation

Question 7

H2RA or PPI in GERD

Answer 7

PPI are superior to H2RA

Question 8

Erosive Esophagitis
- Treatment

Answer 8

PPI are the drug of choice
- Keep indefinitely for maintenance
- No step down therapy to H2RA

Can not reverse Barrett’s esophagus

Question 9

Deprescribing PPIs

Answer 9

PPI Maintenance Therapy appropriate in pts with GERD complications:
- Severe EE
- Barrett’s Esophagus
- Chronic NSAID use
- Bleeding Ulcer

Question 10

Refractory GERD

Answer 10

Not responding to PPI
- First refer to GI Endoscopy
- Switch from Pantoprazole to Rabeprazole
- Same doses, no need for pharmacogenomic testing

Question 11

PPI Counsuling

Answer 11

• Should be taken first thing in the morning
• No clinically important differences between PPIs. Choose based on availability and cost

Question 12

Treating Mild GERD Symptoms

Answer 12

Start PPI with a step up approach

Question 13

Treating Serious GERD Symptoms

Answer 13

Start PPI with a step down approach