GERD

Question 1

Definition of GERD

Answer 1

-chronic sxs or mucosal damage by abnormal reflux of gastric contents into esophagus

Question 2

Sxs of GERD

Answer 2

• heartburn usually aggravated by lying down, large meals
• regurgitation
• dysphagia
• odynophagia

Question 3

Atypical GERD Sxs

Answer 3

• chest pain
• chronic cough
• hoarseness
• asthma
• dental erosions
• pharyngitis

Question 4

Warning Sxs Suggesting Complicated GERD

Answer 4

• continual pain
• dysphagia and odynophagia
• bleeding
• unexplained weight loss > 5%
• unexplained anemia
• choking

Question 5

Factors that Decrease LES Tone

Answer 5

• food: fat, chocolate, peppermint, spearmint, alcohol
• smoking
• meds
• hormones
• pregnancy, chalasia, scleroderma
• direct irritants

Question 6

Drugs that Decrease LES Tone

Answer 6

• DHP calcium channel blockers
• estrogen, progesterone
• theophylline
• nitrates, narcotics, nicotine
• anticholinergics, benzos, dopamine, caffeine, ethanol, phentolamine

Question 7

Treatment Goals for GERD

Answer 7

• alleviate sxs
• decrease frequency of recurrent dz
• promote healing of mucosal injury
• prevent complications (Barrett’s esophagus and esophageal CA)

Question 8

Lifestyle Modifications for GERD

Answer 8

• elevate head of bed
• dietary changes: weight reduction, avoid foods that decrease LES tone, avoid spicy foods, eat small meals, avoid eating 2-3 hrs before bed, protein rich diet
• avoid alcohol
• avoid tight fitting clothes
• stop smoking
• D/C meds that may promote reflux (CCB, nitrates, theophylline)

Question 9

Antacids MOA

Answer 9

gastric acid neutralization

Question 10

Antacids Generics

Answer 10

• aluminum hydroxide
• magnesium hydroxide
• calcium carbonate

Question 11

Antacids Trade Names:

1. aluminum hydroxide
2. magnesium hydroxide
3. calcium carbonate

Answer 11

1. Maalox
2. Mylanta
3. Tums

Question 12

AEs of Antacids

Answer 12

• relatively safe
• hypercalcemia, hypermagnesemia
• Mg: diarrhea
• Al and Ca: constipation

Question 13

Drug Interactions of Antacids

Answer 13

• chelation of TCNs, quinolones, Fe

- decreased absorption of drugs that are preferentially absorbed at low pHs (ketoconazole, TCs)

Question 14

Promotility Agents MOA

Answer 14

increase rate of gastric emptying

Question 15

Promotility Agent Generic and Trade Name

Answer 15

metoclopramide = Reglan

Question 16

AEs of Promotility Agents

Answer 16

• occasional extrapyramidal effects (take benadryl for prophylaxis)
• restlessness, drowsiness, fatigue, N/D
• black box warning for tardive dyskinesia

Question 17

Drug Interactions of Promotility Agents

Answer 17

• increase risk of HTN with MAOI
• increase toxicity of antipsychotics
• decrease absorption of many drugs

Question 18

Treatment Regimen for Intermittent, Mild Heartburn

Answer 18

-lifestyle modifications plus antacids

AND/OR patient directed therapy with OTC H2RA or OTC PPI

Question 19

Treatment Regimen for Symptomatic GERD

Answer 19

-lifestyle modifications 
AND H2RA (6-12 wks) or PPI (4-8 wks)

Question 20

Healing of Erosive Esophagitis or Tx of Mod-Severe Sxs or Complications

Answer 20

-lifestyle modifications plus PPI 4-16 wks

Question 21

If sxs of intermittent, mild heartburn, what should be done if sxs are unrelieved with lifestyle changes and OTC meds?

Answer 21

-begin therapy with standard dose acid-suppressing agent

Question 22

What is a risk of aluminum containing antacids?

Answer 22

aluminum may accumulate in renal failure

Question 23

What GERD meds must be reduced with low CrCl?

Answer 23

• decrease calcium containing antacids

- decrease H2RA by 50%

Question 24

Treatment for Reflux Chest Syndrome

Answer 24

-twice daily PPI

Question 25

Who would be a candidate for antireflux surgery?

Answer 25

-pts not responding to acid suppressing therapy, including those with extraesophageal sxs

Question 26

GERD Treatment Monitoring

Answer 26

• GERD sxs
• complicated sxs
• medication adverse effects