GORD

Question 1

Conservative mx of GORD?

Answer 1

Weight reduction
Avoid precipitating foods
Smoking cessation
Elevate bed (especially with nocturnal sx)

Question 2

Medical mx of GORD?

Answer 2

Review meds- CCBs, nitrates, steroids, NSAIDs, aspirin, clopi, bisphosphonates all associated with GORD

Prescribe antacids and alginates

H2- receptor antagonists

PPIs

Question 3

How do antacids and alginates work?

Answer 3

Form viscous gel that floats on stomach surface to prevent reflex

Relieve mild symptoms

Question 4

What are commonly used antacids and alginates in mx of GORD?

Answer 4

Gaviscon

Peptac

Question 5

How do H2- receptor antagonists work?

Answer 5

Block H2 histamine receptors on gastric parietal cells–> reduced proton pump activity

Question 6

What is the most commonly used H2- receptor antagonist?

Answer 6

Ranitidine

Question 7

Why is the use of H2-receptor antagonists in management of GORD limited?

Answer 7

Reduced efficacy within 2-6 weeks of initiation due to tachyphylaxis

Question 8

What is the gold standard treatment of moderate to severe GORD

Answer 8

PPIs

Question 9

How do PPIs work?

Answer 9

Inhibit H/K proton pump on gastric parietal cells, significantly increasing gastric pH

Question 10

When should PPIs be taken?

Answer 10

Morning at least 30 minutes before first meal of the day

Question 11

What PPI is generally prescribed and why?

Answer 11

Omeprazole- cheapest

No difference between different PPIs

Question 12

How should PPIs be prescribed for GORD?

Answer 12

Full dose OD for 4-8 weeks e.g. omeprazole 40mg

If unresponsive, either increase PPI (e.g. 40mg BD) or switch to alternate PPI

If unresponsive refer for OGD

Question 13

How should you take patients off PPIs?

Answer 13

Try off period after 4-8 weeks

In those whose sx recur (majority), restart PPI and titrate down to lowest effective dose

Some its may only need as a “pill in pocket”