Stomach Disorders: GERD

Question 1

What does GERD stand for?

Answer 1

• Gastroesophageal Reflux Disease

Question 2

What is the difference between a disease and a syndrome?

Answer 2

• A disease can be defined as a health condition that has a clearly defined reason behind it
• A syndrome may produce a number of symptoms without an identifiable cause

Question 3

Is GERD a disease or syndrome?

Answer 3

• Syndrome

Question 4

What causes GERD?

Answer 4

• If the cardiac sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus.
• This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed.
• This can cause pain an irritation as well as pulmonary aspiration

Question 5

What is the acronym for remembering the s/s of GERD? Name each letter.

Answer 5

• DRED PP FOH
• D: Dyspepsia
• R: Regurgitation
• E: Eructation (burping)
• D: Dysphagia
• P: Pyrosis
• P: Pulmonary symptoms (coughing)
• F: Flatulence
• O: Odynophagia (painful swallowing)
• H: Hypersalivation

Question 6

What factors make up the GERD condition?

Answer 6

• Impaired esophageal motility
• Delayed gastric emptying
• Defective mucosal defense
• Lower esophageal sphincter dysfunction
• Reflux of gastric contents

Question 7

What diagnostic tests are run for GERD?

Answer 7

• Endoscopy (EGD)
• Biopsy
• Esophageal manometry

Question 8

What is an Endoscopy (EGD)

Answer 8

• Upper endoscopy, also known as esophagogastroduodenoscopy (EGD)
• A procedure used to examine the lining of the esophagus, stomach, and the duodenum.
• The doctor may perform this procedure to diagnose and treat certain disorders of the upper GI tract (ex. GERD)

Question 9

What is Esophageal Manometry?

Answer 9

• A test that shows whether your esophagus is working properly
• It measures esophageal contractions.
• The test also measures the force and coordination of esophageal muscles as they move food to your stomach

Question 10

What are some lifestyle changes to manage GERD symptoms?

Answer 10

• HOB 30 degrees (6”-12”)
• Stop smoking/alcohol
• Small frequent meals
• Weight reduction
• Avoid eating and drinking 2 hours before bedtime
• No tight/restrictive clothing
• Avoid heavy lifting, straining, working in a bent over position

Question 11

What is some diet guidance to provide for management of GERD symptoms?

Answer 11

• Low fat (longer to digest), high fiber (normalizes bowel movement) diet
• Avoid:
  
  • CCC FAMA
  • Caffeine
  • Carbonated beverages
  • Chocolate
  • Fatty (fried) foods
  • Acidic foods/drink
  • Milk products
  • Alcohol

Question 12

What drug therapy may be used for GERD?

Answer 12

• Antacids (though not effective long term)
• H2R Blockers: acid reducer
• PPIs: acid reducer
• Zegerid: PPI w/ NaHCO3 (salt)
• Kapidex (Dexilant): double release PPI

Question 13

What absorbs more quickly, tab or liquid?

Answer 13

• Liquid

Question 14

What do we keep in mind with PPIs and meals?

Answer 14

• Most effective if taken 30 mins before (though can still take w/ meal)

Question 15

What kind of meds should be avoided with GERD?

Answer 15

• Anticholinergics

Question 16

When non-pharmaceutical therapies are available for GERD?

Answer 16

• Surgical therapy to enhance integrity of cardiac sphincter
• Endoscopic therapy (various types)

Question 17

What is Barrett’s Esophagus?

Answer 17

• A condition in which the flat pink lining of the esophagus becomes damaged by acid reflux, which causes the lining to thicken and become red
• This irritation increases the risk of dysplasia formation and cancer development

Question 18

What tx follows ID of Barrett’s Esophagus?

Answer 18

• GERD tx
• Continual endoscopic monitoring for dysplasia formation every 1-3yrs

Question 19

What is a Mallory-Weiss tear?

Answer 19

• A tear in the mucosal layer at the junction of the esophagus and stomach
• Can be caused by acid reflux of GERD, violent coughing or vomiting

Question 20

What results are desired from medication therapy of GERD?

Answer 20

• ↓ Volume & acidity of reflux
• Improved LES functionality
• ↑ esophageal clearance
• Protect esophageal mucosa

Question 21

What is the most effective class of drug for GERD? What is its main sfx?

Answer 21

• PPIs
• SFX
  
  • HA
  • ↓ ileum absorption of
    
    • Intrinsic factor secretion (B12 absorption)
    • Calcium, long-term use @risk for fx

Question 22

What is a common naming suffix for PPIs?

Answer 22

• -prazole

Question 23

What is the onset and duration of H2 Receptor Blockers?

Answer 23

• Onset = 1hr
• Duration = 12hrs

Question 24

What are the available routes for H2R blockers?

Answer 24

• Oral, IV, Combined w/ antacid

Question 25

How do Prokinetic drugs help with GERD?

Answer 25

• Increase gastric emptying and motility
• Reduce risk of acid reflux

Question 26

What are the SFX of Prokinetic use?

Answer 26

• CNS (anxiety to hallucinations)
• Extrapyramidal effects (tremors and dyskinesia

Question 27

Name one prokinetic used for GERD.

Answer 27

• Metoclopramide (Reglan)

Question 28

What drugs are contraindicated for antacids use?

Answer 28

• Digoxin
• Tetracycline
• Aspirin
• Iron
• Inderol

Question 29

What type of drug is Sucralfate (Carafate) and why is it used?

Answer 29

• Antiulcer
• Protect surface mucosa of stomach

Question 30

What are the pro’s and con’s of using a cholinergic drug for GERD?

Answer 30

• Pro
  
  • Increased LES pressure
  • Improved esophageal emptying
  • Increased gastric emptying
• • Con
  
  • Increased HCl acid secretion

Question 31

Name 1 cholinergic drug used for GERD.

Answer 31

• Bethanechol (Urecholine)

Question 32

What is our post-operative care for GERD?

Answer 32

• Prevention of respiratory complications
• Maintenance of fluid/electrolyte balance
• Prevention of infection