GERD

Question 1

NERD

Answer 1

Heartburn with normal appearing esophageal mucosa on
endoscopy
• Most common form of GERD
less responsive to PPI

Question 2

TLERs are induced by?

are inhibited by?

Answer 2

gastric distention,
impaired esophageal
clearance, and retrograde
flow of acid and bile

inhib by GABA

Question 3

Root causes of NERD

Answer 3

Stress
Gut dysmotility
Bile reflux
Poor diet
Obesity

Question 4

foods that decrease LES pressure

Answer 4

Alcohol,
chocolate,
coffee, tea

Question 5

% of PPI nonresponders

Answer 5

30-40%

Question 6

PPIS and covid

Answer 6

higher if PPI, higehr if BID

not with H2 blocker

Question 7

risk of gastro with PPIS

Answer 7

increased

Question 8

PPI higher risk of

Answer 8

DM
fractures (childhood)
CKD
dysbiosis

Question 9

How to wean a PPI

Answer 9

Game plan for Weaning:
• Always should be done under supervision
• Never cold turkey a PPI!
• Correct underlying pathophysiology while maintaining acidsuppression (gastroparesis, stress, etc.) and adding supplements (DGL, Zn Carnosine, etc.)
• Alternate days PPI while adding a gentle form of acid
suppression: e.g. H2 blocker or melatonin
• Maintenance gentle acid suppression
• Switch to OTC PRN

Question 10

supplements for GERD

Answer 10

DGL (licorice)
Zn Carnosine
slippery elm

Question 11

Gentle acid-blockers

Answer 11

H2 blocker or melatonin

Question 12

Reasons to Not discontinue PPI

Answer 12

Barrett’s esophagus
chronic NSAID use with bleeding risk
severe esophagitis
documented history of bleeding GI ulcer

Question 13

Foods to avoid for GERD

Answer 13

Chocolate
Citrus fruits/fruit juices
Tomatoes
Peppermint
Onions/garlic
High-fat meals
Carbonation

Question 14

Lifestyle interventions for GERD

Answer 14

Small meal size
• Weight loss
• Smoking cessation
• Avoidance of alcohol (in particular
white wine)
• Elevation of the head of the bed
• Sleeping in the left lateral decubitus
position
• No meals within 3 hours of sleeping

Question 15

diets for GERD

Answer 15

Med diet plus alk water better than PPI

low carb diet

Question 16

Alternative Therapies for GERD

Answer 16

Acupuncture
Low carbohydrate diet
Melatonin
Reduction of hiatal hernia; chiropractic, osteopathic, visceral manipulation

Question 17

prokinetic Therapies for GERD

Answer 17

Iberogast, D-Limonene

Question 18

(repair) Therapies for GERD

Answer 18

Aloe vera,

zinc l-carnosine

Question 19

Alternative Therapies for Functional Dyspepsia

Answer 19

• Capsaicin
• Rikkunshito (TJ-43)
• Peppermint/Caraway oil
• Iberogast
• Ginger

Question 20

GERD assoc with

Answer 20

It is associated with IBS, non-ulcer dyspepsia, gallbladder dyskinesia, gastroparesis, visceral pain syndromes.

Question 21

root causes of GERD

Answer 21

anxiety/stress, gut dysmotility, obesity,

lifestyle modification)

Question 22

dietary supplements FOR GERD

Answer 22

Zn-carnosine,
TJ43,
Alginate bicarbonate,
Iberogast,

Question 23

should you de-prescribe PPIs with Barrett’s esophagus?

Answer 23

NO!

Question 24

Raft Forming Agents for GERD

Answer 24

alginate,
pectin,
carbenoxolone

Question 25

Anti-anxiety for GERD -

Answer 25

Lemon Balm

Question 26

Anti-oxidants for GERD

Answer 26

Artemisia asiatica
Curcumin
Quercitin
Vitamin E