Term
| How is a GERD diagnosis confirmed? |
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Definition
Endoscopy
pH monitoring for persistant symptoms
Manometry for antireflux surgery candidates |
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Term
| How does GERD therapy progress? |
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Definition
Lifestyle changes
Acid-suppression therapy --> do not respond? Endoscopy |
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Term
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Definition
| The LES doesn't close properly |
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Term
| What is Barrett esophagitis? |
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Definition
A precursor to cancer common in white males
Change in composition of the esophagus due to attempts at healing |
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Term
| What factors contribute to GERD? |
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Definition
- Obesity
- Smoking
- Alcohol
- Certain foods/meds
- LES tone - altered or reduced. Protective factors gone, aggressive factors unchecked. |
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Term
| What foods/medications irritate esophageal mucosa? |
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Definition
- Food: spicy foods, orange/tomato juice, coffee
- Meds: ASA, BISPHOSPONATES, NSAIDs, Fe, Quinidine, KCl |
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Term
| What are schatzki's rings? |
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Definition
| A narrowing of the esophagus - food does not go through well. |
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Term
| What factors can aggravate GERD? |
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Definition
A recumbent position
Bending over
High fat content meals |
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Term
| What conditions can be mistaken for GERD? |
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Definition
|
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Term
|
Definition
History, then 2 week trial w/ PPI
Definitive: Endoscopy, pH monitoring, manometry. PillCAM |
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Term
| What are first level recommendations for GERD Tx? |
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Definition
| GERD will required continuous acid suppression therapy w/ a PPI. W/O continuous therapy, relapse is possible. |
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Term
| What is the treatment for mild heartburn? |
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Definition
Lifestyle modification?
Antacids: Maalox, Gaviscon, CaCO3 prn AND/or OTC H2 antagonists or PPIs |
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Term
| What is the tx for symptomatic relief of GERD? |
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Definition
Either H2 antagonists (mild GERD): Cimetidine 400 BID, Famotidine 20 BID, Nizatidine 20 BID, or Ranitidine 150 BID
OR
PPI (Moderate to severe): Dexilant 30, Nexium 20, Prevacid 15, Omeprazole 20, Pantoprazole 40, Aciphex 20 |
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Term
| What is the tx for healing of esophagitis, tx of severe complications? |
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Definition
PPIs: Dexilant 60, Nexium 40, Prevacid 30, Omeprazole 20, Pantoprazole 40, Aciphex 20
H2 antagonists high dose: Tagamet 400 mg QID or 800 mg BID, Famotidine 40 BID, Axid 150 QID, Raniditine 150 QID |
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Term
| What are the nonpharmacologic tx for GERD? |
|
Definition
- Elevation of the head while sleeping, but avoid special pillows.
- Weight reduction
- Avoid fats, chocolate, alcohol, mints
- Include protein in meals
- Avoid acidic and irritating foods
- Avoid large meals, tight clothes, smoking, alcohol, irritating meds. |
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Term
| What are the AEs of antacid Tx? |
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Definition
- Mg (diarrhea) and Al (constipation)
- Acid-base disturbances
- decr in BMD w/ chronic use due to aluminum
** Binding of meds by magnesium |
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Term
| What are the pros/cons of antacid tx? |
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Definition
PROS: Readily available, rapid and inexpensive. Incr LES pressure, incr pH (decr pepsin conversion)
CONS: brief relief, no nocturnal relief. Not effective in healing. many AE and DIs. |
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Term
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Definition
| In gaviscon, does not neutralize acid or increase pressure, but floats on the surface and protects esophagus |
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Term
| What is simethicone used for? |
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Definition
| For relief of gas - changes surface tension |
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Term
| What are H2 antagonists used for? |
|
Definition
For symptomatic relief, for mild GERD
effective for NOCTURNAL acid secretion
d/c = rebound |
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Term
| What AEs are seen with H2 antagonists? |
|
Definition
CNS effects in high doses, the elderly. Effects lactation
Cimetidine has a lot of DIs |
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Term
| What place do PPIs have in Tx for GERD? |
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Definition
Most potent - for moderate to severe GERD
**Must decr dose for HEPATIC impairment
**Asians metabolize more, give a lower dose due to 2C19 |
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Term
| What are common PPI drug interactions? |
|
Definition
- Decr absorption of B12
- Decr absorption of AIDS drugs
- Incr dig toxicity
- Avoid Plavix and OMEPRAZOLE. PPI of choice is pantoprazole |
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Term
|
Definition
- GI: Nausea, constipation
- CNS: HA, dizzy
- Hypochlorhydria - B12 deficiency, incr suscp to nosocomial pneumonia and c. diff.
- Fracture risk w/ long term use - harder to absorb calcium. |
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