GERD

Question 1

Gerd s/sx

Answer 1

heartburn x>3mo w chronic sx
refractory to OTC tx
lower esophagela sphincter issues
dyspepsia = discomfort in epigastrium/bra line (pain, burning, fullness, gnawing, bloating, early satiety)

Question 2

dyspepsia could be

Answer 2

GERD, PUD, gastroparesis, gall bladder issues

Question 3

heartburn could be

Answer 3

GERD only

Question 4

GERD patho

Answer 4

LES opens

barretts esophagus recurrent injury, scar, cancer risk

Question 5

GERD Dx

Answer 5

sx
trial tx works
endoscopy (esp if pain and difficulty swallowing, dyspeptic sx)

Question 6

GERD tx goals

Answer 6

relieve sx, heal damaged mucosa, prevent issues like barretts esophageal adenocarcinoma

Question 7

GERD first line

Answer 7

PPIs x8weeks!

Question 8

If a pt has barretts do they receive acute or chronic PPI therapy

Answer 8

chronic

Question 9

if a pt has sx return when they try to d/c PPI what do we do

Answer 9

titrate down to lowest effective dose or can do TID, prn etc. for PPI, H2RA, antacids

Question 10

why do we titrate down PPIs

Answer 10

to prevent AE!
inc infections (c diff, CAP, renal injury, thrombocytopenia, CNS AE (elderly confusion), OP and frax risk d/t dec Ca absorption

Question 11

GERD lifestyle mods

Answer 11

dec meal size

lose weight