Module 1 GERD

Question 1

Clinical Presentation of GERD: Typical symptoms

Answer 1

Heartburn often described as a substernal sensation of warm or burning rising up from the abdomen that may radiate to the neck and may be waxing and waning character; hypersalivation; regurgitation; belching

Example sentence: The patient presented with typical symptoms of GERD including heartburn and regurgitation.

Question 2

Clinical Presentation of GERD: Atypical symptoms

Answer 2

Chronic cough, laryngitis, hoarseness, wheezing, noncardiac chest pain, asthma (-50% with asthma have GERD)

Example sentence: The atypical symptoms of GERD, such as chronic cough and hoarseness, should be considered alongside typical symptoms for diagnosis.

Question 3

Clinical Presentation of GERD: Alarm symptoms

Answer 3

Dysphagia, odynophagia

Example sentence: Alarm symptoms like dysphagia and odynophagia may require further diagnostic evaluation for potential GERD complications.

Question 4

Desired Outcomes of GERD treatment

Answer 4

Alleviate symptoms, decrease frequency of recurrent disease, promote healing of mucosal injury, and prevent complications

Source: Text

Question 5

General Approach to GERD Treatment

Answer 5

Involves patient-specific lifestyle changes, pharmacologic intervention primarily with acid-suppressing therapy, or antireflux surgery

Source: Text

Question 6

Recommended Regimen for GERD in Adults

Answer 6

Source: Text

Question 7

Therapeutic Approach to GERD in Adults: Intermittent, Mild Heartburn

Answer 7

Individualized lifestyle modifications + patient-directed therapy with antacids and/or nonprescription H2RA or PPI

Lifestyle modifications should be individualized for each patient

Question 8

Antacids (≥ 12 years old)

Answer 8

Maalox: 10-20 mL as needed or after meals and at bedtime

If symptoms are unrelieved with lifestyle modifications and nonprescription medications after 2 weeks, patient should seek medical attention; do not exceed 16 teaspoonfuls per 24 hours

Question 9

Antacid/alginic acid (≥ 12 years old)

Answer 9

Gaviscon: 2-4 tablets or 10-20 mL after meals and at bedtime

Content of alginic acid varies greatly among products; the higher the alginic acid, the better

Question 10

Calcium carbonate (≥ 12 years old)

Answer 10

Tums: 500 mg, 2-4 tablets as needed

If symptoms are unrelieved with lifestyle modifications and nonprescription H2RA after 2 weeks, patient should seek medical attention

Question 11

Patient-directed therapy with nonprescription H2RA (≥ 12 years old)

Answer 11

Tagamet HB: 200 mg

Pepcid AC: 10-20 mg

Axid AR: 75 mg

If symptoms are unrelieved with lifestyle modifications and nonprescription H2RA after 2 weeks, patient should seek medical attention

Question 12

Patient-directed therapy with nonprescription PPI (> 18 years old)

Answer 12

Nexium 24HR: 20 mg

Prevacid 24HR: 15 mg

Prilosec OTC: 20 mg

Zegerid OTC: 20 mg/1100 mg

If symptoms are unrelieved with lifestyle modifications and nonprescription PPI after 2 weeks, patient should seek medical attention

Question 13

Symptomatic Relief of GERD: Prescription-strength H2RA or PPI

Answer 13

Individualized lifestyle modifications + prescription-strength H2RA or PPI

Lifestyle modifications should be individualized for each patient

Question 14

Prescription-strength H2RA

Answer 14

Cimetidine (off-label use): 400 mg four times daily or 800 mg twice daily

Famotidine: 20 mg twice daily

Nizatidine: 150 mg twice daily

For typical symptoms, treat empirically with prescription-strength acid suppression therapy

Question 15

Prescription-strength PPI

Answer 15

Dexilansoprazole: 30 mg once daily for 4 weeks

Esomeprazole: 20-40 mg once daily

Lansoprazole: 15 mg once daily

Omeprazole: 20 mg once daily

Omeprazole/sodium bicarbonate: 20 mg once daily

Pantoprazole (Off-label use): 40 mg once daily

Rabeprazole: 20 mg once daily

For typical symptoms, treat empirically with prescription-strength acid suppression therapy