Stomach Disorders: GERD Flashcards
What does GERD stand for?
• Gastroesophageal Reflux Disease
What is the difference between a disease and a syndrome?
- 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
Is GERD a disease or syndrome?
• Syndrome
What causes GERD?
- 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
What is the acronym for remembering the s/s of GERD? Name each letter.
- 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
What factors make up the GERD condition?
- Impaired esophageal motility
- Delayed gastric emptying
- Defective mucosal defense
- Lower esophageal sphincter dysfunction
- Reflux of gastric contents
What diagnostic tests are run for GERD?
- Endoscopy (EGD)
- Biopsy
- Esophageal manometry
What is an Endoscopy (EGD)
- 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)
What is Esophageal Manometry?
- 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
What are some lifestyle changes to manage GERD symptoms?
- 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
What is some diet guidance to provide for management of GERD symptoms?
- 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
What drug therapy may be used for GERD?
- Antacids (though not effective long term)
- H2R Blockers: acid reducer
- PPIs: acid reducer
- Zegerid: PPI w/ NaHCO3 (salt)
- Kapidex (Dexilant): double release PPI
What absorbs more quickly, tab or liquid?
• Liquid
What do we keep in mind with PPIs and meals?
• Most effective if taken 30 mins before (though can still take w/ meal)
What kind of meds should be avoided with GERD?
• Anticholinergics
When non-pharmaceutical therapies are available for GERD?
- Surgical therapy to enhance integrity of cardiac sphincter
- Endoscopic therapy (various types)
What is Barrett’s Esophagus?
- 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
What tx follows ID of Barrett’s Esophagus?
- GERD tx
- Continual endoscopic monitoring for dysplasia formation every 1-3yrs
What is a Mallory-Weiss tear?
- 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
What results are desired from medication therapy of GERD?
- ↓ Volume & acidity of reflux
- Improved LES functionality
- ↑ esophageal clearance
- Protect esophageal mucosa
What is the most effective class of drug for GERD? What is its main sfx?
- PPIs
- SFX
- HA
- ↓ ileum absorption of
- Intrinsic factor secretion (B12 absorption)
- Calcium, long-term use @risk for fx
What is a common naming suffix for PPIs?
• -prazole
What is the onset and duration of H2 Receptor Blockers?
- Onset = 1hr
- Duration = 12hrs
What are the available routes for H2R blockers?
• Oral, IV, Combined w/ antacid
How do Prokinetic drugs help with GERD?
- Increase gastric emptying and motility
- Reduce risk of acid reflux
What are the SFX of Prokinetic use?
- CNS (anxiety to hallucinations)
- Extrapyramidal effects (tremors and dyskinesia
Name one prokinetic used for GERD.
- Metoclopramide (Reglan)
What drugs are contraindicated for antacids use?
- Digoxin
- Tetracycline
- Aspirin
- Iron
- Inderol
What type of drug is Sucralfate (Carafate) and why is it used?
- Antiulcer
- Protect surface mucosa of stomach
What are the pro’s and con’s of using a cholinergic drug for GERD?
- Pro
- Increased LES pressure
- Improved esophageal emptying
- Increased gastric emptying
- • Con
- Increased HCl acid secretion
Name 1 cholinergic drug used for GERD.
• Bethanechol (Urecholine)
What is our post-operative care for GERD?
- Prevention of respiratory complications
- Maintenance of fluid/electrolyte balance
- Prevention of infection
