GERD Flashcards
Definition of GERD
-chronic sxs or mucosal damage by abnormal reflux of gastric contents into esophagus
Sxs of GERD
- heartburn usually aggravated by lying down, large meals
- regurgitation
- dysphagia
- odynophagia
Atypical GERD Sxs
- chest pain
- chronic cough
- hoarseness
- asthma
- dental erosions
- pharyngitis
Warning Sxs Suggesting Complicated GERD
- continual pain
- dysphagia and odynophagia
- bleeding
- unexplained weight loss > 5%
- unexplained anemia
- choking
Factors that Decrease LES Tone
- food: fat, chocolate, peppermint, spearmint, alcohol
- smoking
- meds
- hormones
- pregnancy, chalasia, scleroderma
- direct irritants
Drugs that Decrease LES Tone
- DHP calcium channel blockers
- estrogen, progesterone
- theophylline
- nitrates, narcotics, nicotine
- anticholinergics, benzos, dopamine, caffeine, ethanol, phentolamine
Treatment Goals for GERD
- alleviate sxs
- decrease frequency of recurrent dz
- promote healing of mucosal injury
- prevent complications (Barrett’s esophagus and esophageal CA)
Lifestyle Modifications for GERD
- 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)
Antacids MOA
gastric acid neutralization
Antacids Generics
- aluminum hydroxide
- magnesium hydroxide
- calcium carbonate
Antacids Trade Names:
- aluminum hydroxide
- magnesium hydroxide
- calcium carbonate
- Maalox
- Mylanta
- Tums
AEs of Antacids
- relatively safe
- hypercalcemia, hypermagnesemia
- Mg: diarrhea
- Al and Ca: constipation
Drug Interactions of Antacids
- chelation of TCNs, quinolones, Fe
- decreased absorption of drugs that are preferentially absorbed at low pHs (ketoconazole, TCs)
Promotility Agents MOA
increase rate of gastric emptying
Promotility Agent Generic and Trade Name
metoclopramide = Reglan
AEs of Promotility Agents
- occasional extrapyramidal effects (take benadryl for prophylaxis)
- restlessness, drowsiness, fatigue, N/D
- black box warning for tardive dyskinesia
Drug Interactions of Promotility Agents
- increase risk of HTN with MAOI
- increase toxicity of antipsychotics
- decrease absorption of many drugs
Treatment Regimen for Intermittent, Mild Heartburn
-lifestyle modifications plus antacids
AND/OR patient directed therapy with OTC H2RA or OTC PPI
Treatment Regimen for Symptomatic GERD
-lifestyle modifications AND H2RA (6-12 wks) or PPI (4-8 wks)
Healing of Erosive Esophagitis or Tx of Mod-Severe Sxs or Complications
-lifestyle modifications plus PPI 4-16 wks
If sxs of intermittent, mild heartburn, what should be done if sxs are unrelieved with lifestyle changes and OTC meds?
-begin therapy with standard dose acid-suppressing agent
What is a risk of aluminum containing antacids?
aluminum may accumulate in renal failure
What GERD meds must be reduced with low CrCl?
- decrease calcium containing antacids
- decrease H2RA by 50%
Treatment for Reflux Chest Syndrome
-twice daily PPI
Who would be a candidate for antireflux surgery?
-pts not responding to acid suppressing therapy, including those with extraesophageal sxs
GERD Treatment Monitoring
- GERD sxs
- complicated sxs
- medication adverse effects
