Topic 7: GERD

Question 1

GERD results when

Answer 1

reflux of acidic gastric contents into the esophagus overwhelms the esophageal defenses. Gastric HCl acid and pepsin secretions in refluxate cause esophageal irritation and esophagitis.

Question 2

what is the primary cause of GERD

Answer 2

Primary cause is incompetent LES.

Question 3

Clinical manifestations

GERD

Answer 3

· Heartburn (pyrosis)
· GERD-related chest pain (can mimic angina): describes as burning beneath lower sternum; squeezing or radiating to the back, neck, jaw, or arms
· Dyspepsia
· Regurgitation
Otolaryngologic symptoms:

Question 4

GERD chest pain is relieved with

Answer 4

antacids

Question 5

pyrosis

Answer 5

heartburn

Question 6

dyspepsia

Answer 6

o Pain/discomfort centered in the upper abdomen

Question 7

· Regurgitation

Answer 7

o Hot, bitter, or sour liquid coming into the mouth or throat

Question 8

Otolaryngologic symptoms:

Answer 8

· hoarseness, sore throat, globus sensation (sense of lump in the throat), hypersalivation, and choking

Question 9

complications of GERD

Answer 9

· Barrett’s esophagus (esophageal metaplasia)
· Esophageal Varices
· Esophageal Ulcers
· From irritation of upper airway by secretions (cough bronchospasm laryngospasm)

Question 10

Diagnostic assessment:

Answer 10

· History and physical exam
· Upper GI ENDOSCOPY with biopsy and cytologic analysis (assess the LES competence)
· Esophagram (barium swallow)
· Motility (manometry) studies (measure pressure in esophagus and LES)
· pH monitoring
Radionuclide studies

Question 11

GERD management

Answer 11

· Elevate head of bed 30 degrees
· Do not lie down for 2-3 hours after eating
· Teach to avoid factors that trigger symptoms
· Stop smoking
· Avoid alcohol and caffeine
· Avoid reflux-inducing foods (fatty foods, chocolate, peppermint) and acidic foods
· Reduce or avoid acidic pH beverages (cola, red wine, orange juice)
· Stress reduction techniques
· Weight reduction, if appropriate
· Small, frequent meals

Question 12

what foods should be avoided with GERD

Answer 12

fatty foods, chocolate, peppermint and acidic foods

Question 13

what drinks should be avoided with GERD

Answer 13

acidic pH beverages (cola, red wine, orange juice)
alcohol and caffeine

Question 14

LINX reflux management system

Answer 14

· A ring of small flexible magnets enclosed in titanium beads and connected titanium wires, implanted laparoscopically and the ring strengthens the LES

Question 15

Nissen fundoplication

Answer 15

a surgical technique used to suture the fundus of the stomach around the esophagus to prevent reflux

Question 16

Teaching

Answer 16

· Explain reason for low-fat diet
· Have patient eat small, frequent meals to prevent gastric dissention
· Do not lie down 2-3 hours after eating or bend over after eating
· Do not wear tight clothing around the waist
· Avoid eating 3 hours before bedtime
· Sleep with HOB elevated
· Discuss weight reduction strategies if appropriate

Question 17

PPI examples

Answer 17

omeprazole (Prilosec)

Question 18

PPIs (ex: omeprazole (Prilosec)) SE

Answer 18

HA (MOST COMMON), abdominal pain, nausea, diarrhea, vomiting, flatulence

Question 19

PPIs (ex: omeprazole (Prilosec)) long term use…

Answer 19

increase the risk for fractures of hip, wrist and spine

Question 20

H2 receptor blockers example

Answer 20

cimetidine (Not as widely used) Now ranitidine (Zantac) and famotidine (Pepcid)

Question 21

antacids example

Answer 21

Maalox, Mylanta

Question 22

when are antacids take

Answer 22

Taken 1-3 hours after meals/at bedtime

Question 23

· Aluminum hydroxide SE

Answer 23

constipation, phosphorus depletion with chronic use

Question 24

Calcium carbonate SE

Answer 24

constipation or diarrhea, hypercalcemia, milk-alkali syndrome, renal calculi

Question 25

· Magnesium preparations SE

Answer 25

diarrhea, hypermagnesemia

Question 26

· Sodium preparations SE

Answer 26

o milk-alkali syndrome if used with large amounts of calcium
o Use with caution in patients on sodium restriction (ex: HF)

Question 27

Prokinetic drug therapy example

Answer 27

metoclopramide (Reglan)

Question 28

Prokinetic drug therapy use

Answer 28

· Promote gastric emptying
· Reduce risk of gastric acid reflux

Question 29

Acid protective example

Answer 29

Sucralfate

Question 30

Acid protective (Sucralfate) use

Answer 30

· Used for cytoprotective properties