GERD/PUD Flashcards
Heartburn
Burning sensation in chest that moves up back of throat
OTC treatment for Heartburn/GERD
- Antacids (Tums)
- H2RAs (Famotidine)
- PPIs (Omeprazole) x14 days
Dyspepsia
“Indigestion” - discomfort in epigastrium (midline)
Gnawing/Pain/Fullness
May be meal independent
When to initiate Rx therapy for GERD
Symptoms 1-2 times per week for ~3 months
Failure to respond to OTC therapy
GERD Alarm Symptoms (require GI workup)
Chest Pain (rule out cardiac causes)
GI Bleeding
Unexplained weight loss
Dysphasia
Anorexia (dec appetite)
Empiric therapy for GERD/PUD
PPI QD x 8 weeks
GERD S/Sx
Substernal Pain
Sour/Spicy taste in back of throat
Treatment if unresolved after stopping empiric therapy for GERD
Lowest dose of PPI possible that relieves symptoms
Treatment if empiric therapy FAILS for GERD
a. Titrate to PPI BID therapy (ensuring proper adherence)
b. PPI QD + H2RA at night (may develop H2RA tolerance)
Lifestyle Modifications for GERD
Small, frequent meals
Remain upright after eating
Weight loss
Smoking cessation
Prop head of bed with foam wedge
Avoid trigger foods (spicy, acidic, caffeine, tobacco)
Avoid tight fitting clothes
When is long term therapy for GERD required
Barrett’s Esophagus
GERD complications (strictures, erosive esophagitis)
PPI long-term ADEs
Inc risk bone fracture
C. Diff/Gastroenteritis
B12 deficiency
CKD (due to Acute Interstitial Nephritis)
Dementia
3 year RCT - What was only relevant ADE from long-term PPI?
Gastroenteritis
PUD S/Sx
Dyspepsia #1
Epigastric pain/gnawing
Early satiety
Pain that awakens from sleep
GI bleed
PUD Causes
H. pylori, NSAIDs
Diagnosis for H. Pylori
a. Invasive:
- *Endoscopic - tissue culture
b. Noninvasive:
- *Antibody blood test
- Urea breath test - confirms eradication
- Fecal antigen test - confirms eradication
PUD Therapies - H. pylori
1st line - Bismuth Quad Therapy
1. PPI BID
2. Bismuth subsalicylate 500 BID
3. Tetracycline 500 QID
4. Metronidazole 250 QID
2nd line - Triple therapy
1. PPI BID
2. Clarithromycin 500 BIID
3. Amoxicillin 1g BID
Duration of H. Pylori treamtent
14 days (for both)
NSAID ulcers RFs
Previous history PUD #1
Age > 65
Concomitant steroids
Non-COX2 selective NSAIDs
Anticoagulants
Antiplatelets
High Doses
Multiple NSAIDs (including Aspirin)
PUD Therapies - NSAID
4-8 weeks daily PPI use if the NSAID can be D/C. If not, then consider long term therapy
NSAID alternatives
APAP
Misoprostol + NSAID
Cox-2 selective NSAID
Preferred COX2-selective NSAIDs
*Celecoxib
Nabumetone
Meloxicam
Etodulac
PUD: Who qualifies for daily PPI therapy?
a. History of PUD
b. >/= 2 risk factors and taking ASA + P2Y12
UGIB S/Sx
Black Stools
Hematemesis
Lightheadedness
Chest Pain
Low Hemoglobin/Hemacrit
Low BP/High HR
UGIB Therapies - Depends on the patient
NS/LR Bolus to restore intravascular volume
Packed RBCs if Hgb <7
O2 supplement if needed
Reverse anticoagulation if they are on anticoagulants
Then endoscopic treatment
UGIB Therapies - within first 72 hours
80mg bolus of IV PPI, then 8 mg/hr infusion
OR
40mg IV BID
UGIB Therapies - beyond first 72 hours
PO PPI BID for at least 2 weeks
Additional 2 weeks if they are on an NSAID
Consider extending therapy if necessary
Add ABX if needed
