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GI Exam 3 > GERD > Flashcards

GERD Flashcards

1
Q

GERD Defined

A

Symptoms of complications resulting from the reflux of gastric contents into the esophagus or beyond, into the oral cavity or lungs

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2
Q

Lower Esophageal Sphincter

A

Only thing that keeps the acid in the stomach

Intra-abdominal pressure can close the pathway

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3
Q

GERD Pathophysiology

A

Caustic Agents of GERD (Acid or Pepsin)
Loss of lower esophageal pressure (most common cause)
Increased gastric pressure (obesity, pregnancy, etc)

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4
Q

Nocturnal Reflux Symptoms

A 
Reduced salivation
Potential absence of arousal 
Potential absence of arousal response to heartburn
Ineffective peristalsis
Absence of gravitational forces
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5
Q

Classic Symptoms Heartburns

A

Exacerbated in supin eo r bending position
Burning sensation right on the sternum
Most common postprandially
>2X week to qualify for GERD

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6
Q

**Alarm Symptoms of GERD

A 
Weight loss
Choking
Odynophagia (painful swallowing)
Chest pain
Bleeding
Dysphagia (difficulty swallowing)
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7
Q

Disease Profile of GERD

A

80% of the time it is just symptoms but 20% of the time the patient will have erosive esophagitis

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8
Q

Complications of GERD

A 
Bleeding
Perforation
Ulcer
Stricture
Barrett's Esophagus
Adenocarcinoma
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9
Q

Primary Therapeutic Objectives

A

Relieve symptoms
Heal esophageal mucosa
Prevent complications

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10
Q

Secondary Therapeutic Objectives

A 
Decrease reflux episodes 
Neutralize reflux
Protect mucosa
Restore LES tone
Increase esophageal clearance
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11
Q

Lifestyle Modifications

A

Weight loss BMI greater than 25
Elevate head of bed
Avoidance of late evening meals
“No kisses (chocolate) before bed”

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12
Q

Things that decreased LES pressure:

A

Fatty meal, chocolate, coffee/cola/tea

Medications (anticholinergics, bisphosphonates, TCA)

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13
Q

Things that are direct irritants to the esophageal mucosa:

A

Spicy foods, orange/tomato juice
Aspirin
NSAIDs
Iron

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14
Q

Pharmacologic Agents

A

-Antacids/Alginic Acids (Gaviscon)
-OTC H2RAs (don’t use in Grade C or D)
Both treat mild GERD
-Prokinetic agents

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15
Q

***Who should NOT be treated with OTC therapy?

A

Heartburn occurring more frequently than 1-2 X per month
Alarm symptoms
Requiring continuous OTC therapy more than 2 weeks

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16
Q

Metoclopramide Use and Effectiveness

A

Similar to H2RA
Healing is dependent on severity of GERD
No more effective than H2RAs and less effective than PPIs
More toxic
SHOULD NOT BE USED MONOTHERAPY OR ADJUNCTIVE THERAPY

17
Q

Other Prokinetic Agents (not metoclopramide)

A

Erythromycin (usually fails)

Bethanechol (too many ADEs)

18
Q

Prescription H2RAs Use in GERD?

A

NOT severe
Relieve symptoms in 80% and heal mucosa in 60-75% of mild GERD
- Develop tolerance to acid suppression over time

19
Q

H2RAs + Severe GERD

A

Use with PPI to the point at which the PPI starts working (2-3 days)

20
Q

PPIs + GERD

A

Moderate to Severe symptomatic GERD

PPIs are more effective than H2RAs and they are all equivalent to each other

21
Q

PPI Dosings

A 
Omeprazole 20 mg QD
Lansoprazole 30 mg QD
Rabeprazole 20 mg QD
Pantoprazole 40 mg QD
Esomeprazole 20 mg QD
Duration: 4-8 weeks
22
Q

At what point should all grades be healed?

A

8 weeks

23
Q

Maintenance Therapy in GERD

A

70-90% relapse within the first 12 months

- Don’t need a supper high dose for maintenance therapy

24
Q

Who will need long-term medical therapy for GERD?

A

Grade C or D and not complicated by GI disturbances related to NSAIDs
Initial presence of GERD requiring strong acid suppression for healing
Occurrence of residual symptoms after healing
Prolonged intitial therapy to relieve symptoms or heal GERD
Long duration of symptoms before intitial therapy

25
Q

Step-Up Treatment Approaches with GERD

A

Patients initially treated with H2RA

Patients not adequately responsive to treatment are switched to PPI

26
Q

Step-Down Treatment Approaches with GERD

A

Patient initially treated with PPI for 8 weeks, then every other day
For patients responding to treatment attempt to step down to H2RA

27
Q

Symptoms DO NOT correlate with

A

Healing of esophagitis

28
Q

Risk of Long-Term PPI Therapy

A

Accelerated risk of gastric cancer with H. pylori gastritis
Vitamin B12 and Calcium malabsorption (Ca leads to osteoporosis)
Increased risk of C. difficile colitits
Increased risk of CAP

29
Q

Define NIS Fundoplication

A

Wrap the stomach around the esophagus and makes a super LES

30
Q

GERD Treatment Non-Pharm

A

Weight loss is recommended
Head of bed elevation and avoidance of meals 2-3 hours before bedtime (nocturnal GERD)
Elimination of food that trigger reflux (chocolate, caffeine, spicy food) is NOT recommended

31
Q

GERD Treatment Pharm

A

-8 week course of PPIs is therapy of choice
Once daily dosing before the first meal and can be titrated to BID
- H2RA can be used as maintenance for patients without erosive disease but with heartburn and can be given at night to help with nocturnal sx
- No role for sucralfate in the non-pregnant GERD pts

GI Exam 3 (9 decks)

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