GERD

Question 1

Stomach contents backflow into the esophagus.

Usually due to the lower esophageal sphincter (LES) relaxing too much or by pyloric stenosis, hiatal hernia etc.

Answer 1

GERD

Question 2

GERD S/Sx

Answer 2

-Dyspepsia (Indigestion) after eating bad food. Lasts 20 mins to 2 hr
-Pyrosis (burning in the esophagus)
-Pain that worsens with positioning & wakes pt up at night

The pain is relieved by sitting up, drinking water, and taking antacids

Question 3

GERD Risk factors

Answer 3

Older age, sleep apnea, NGT
Overeating and pregnancy
**Foods that relax the lower esophageal sphincter (irritants: Acids, Spicy, Fats)

Question 4

Foods that relax the lower esophageal sphincter (LES)

Answer 4

Chocolate, fat, fried foods, coffee, peppermint, spicy food, acidic fruits/veggies, alcohol.

Question 5

GERD diagnosis

Answer 5

-Symptoms 4-5x per week
-EGD: Esophagogastroduodenoscopy
-Esophageal pH monitoring
-Esophageal manometry
-Barium swallow study

Question 6

Procedure for GERD

A surgery in which the upper part of the stomach the fundus is wrapped around the lower esophagus reducing the amount of acid that returns to the esophagus from the stomach.

Answer 6

Fundoplication

Question 7

Complications of GERD

Answer 7

-Aspiration and tooth decay
-Barrett’s epithelium: the acid from the stomach damages the lower esophagus which can cause malignancies
-Most damaging at night

Question 8

Pt education

Answer 8

-Eat 4-6 small meals per day
-Do not snack in the evening or eat 2-3 hours before going to bed
-Chew the food well to reduce belching (burping)
-Sit upright 1-2 hrs after eating
-Never sleep in flat bed
-Lose weight
-Don’t wear constrictive clothing
-Avoid heavy lifting, straining, or working in bent-over position
-Follow antacids with a glass of water

Question 9

Meds for GERD

Answer 9

PPIs, antacids, H2 blockers, & prokinetics

Question 10

PPIs side reminders

-azoles
Ex: Omeprazole

Answer 10

SE: C. Diff and fracture risks if used long term

3 Ps
Prevents holes
Porous bones
Possible C. Diff

Question 11

Antacids reminders

SCAM
Sodium bicarbonate
Calcium carbonate
Aluminum hydroxide
Magnesium hydroxide

Answer 11

SE: hepatoxic

Take 1-3 hrs after eating and at bedtime, and at least 1 hr apart from other drugs.

Question 12

H2 blockers reminders

*tidine
Ex: famotidine

Answer 12

SE: hepatoxic

Take w/ meals

Question 13

Prokinetics reminders

Ex: Metoclopramide

Answer 13

Increases motility of the esophagus and stomach

SE: EPS, hallucinations, and anxiety