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GERD Flashcards

1
Q

Chronic symptoms or mucosal damage produced by abnormal reflux of gastric contents into the esophagus

A

GERD

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2
Q

Prolonged periods of inflammation of the esophagus can progress to what?

A

Erosion of the epithelium of the esophagus

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3
Q

What two things can GERD be further classified as?

A
  1. NERD
  2. ERD
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4
Q

What does NERD stand for?

A

Non-erosive Reflux disease

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5
Q

What does ERD stand for?

A

Erosive reflux disease

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6
Q

What is the most frequent clinical complaint of GERD?

A

Heartburn

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7
Q

What age does GERD most commonly occur?

A

Ages >40

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8
Q

True or False: Males experience GERD more than females

A

False (equal)

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9
Q

True or false: infants can experience GERD

A

True

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10
Q

What are 5 risk factors of GERD?

A
  1. Genetic
  2. Obesity
  3. Excessive alcohol use
  4. Smoking
  5. Excessive coffee intake
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11
Q

What does GERD decrease? 4

A
  1. LES pressure or tone
  2. Clearance of gastric contents
  3. Mucosal resistance
  4. Gastric emptying
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12
Q

What does GERD do to gastric fluid?

A

Makes it extra acidic

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13
Q

GERD can cause a _____ hernia

A

Hiatal

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14
Q

If a patient is experiencing heartburn for _____ on a regular basis it could be GERD

A

> or = 2x/week

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15
Q

What are 4 atypical symptoms of GERD?

A
  1. Chronic cough
  2. Asthma like symptoms
  3. Laryngitis/ hoarseness
  4. Recurrent sore throat
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16
Q

What are 4 alarm symptoms of GERD that you should refer on for?

A
  1. Dysphasia
  2. Odynophagia
  3. Bleeding
  4. Unexplained weight loss
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17
Q

Trouble swallowing

A

Dysphasia

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18
Q

Odynophagia

A

Painful swallowing

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19
Q

What may the alarm symptoms be indicative of?

A

Barretts esophagus

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20
Q

What are 5 aggravating factors of GERD?

A
  1. Recumbancy (lying down)
  2. Increased abdominal pressure
  3. Decrease in gastric motility
  4. Decreased LES
  5. Direct mucosal irritation
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21
Q

What foods can decrease LES pressure?

A
  1. Fatty foods
  2. Peppermint
  3. Spearmint
  4. Chocolate
  5. Coffee
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22
Q

What medications decrease LES pressure? 7

A
  1. Anticholinergics
  2. BZDs
  3. Caffeine
  4. DHP calcium channel blockers
  5. Estrogen
  6. Ethanol
  7. Nicotine
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23
Q

What 4 foods are direct irritants to the esophageal mucosa?

A
  1. Spicy food
  2. Orange juice
  3. Tomato juice
  4. Coffee
24
Q

What 5 medications are direct irritants to the esophageal mucosa?

A
  1. Oral bisphosphonates
  2. Aspirin
  3. Iron
  4. NSAIDs
  5. Potassium
25
When normal squamous epithelium may convert to a columnar cell epithelium after long standing disease
Barrett’s esophagus
26
Those with Barrett’s esophagus can develop what?
Adenocarcinoma
27
When should patients be monitored for adenocarcinoma?
Every few years
28
What is heartburn also known as?
Pyrosis
29
When is invasive testing not indicated?
In uncomplicated GERD
30
Technique of choice to identify complication of GERD
Endoscopy
31
What is the mainstay of therapy for GERD?
PPIs
32
What are three agents primarily used to treat GERD?
1. PPIs 2. H2 antagonists 3. Antacids or alginic products
33
Why are PPIs preferred over H2RAs?
PPIs have faster esophageal healing rates and faster, more complete heartburn relief
34
When should Omeprazole be taken?
30-60 minutes before a meal (usually breakfast)
35
What 3 PPIs can be taken without regard to meals?
1. Dexlansoprazole 2. Pantoprazole 3. Rabeprazole
36
What are 4 warnings associated with the PPIs?
1. C-diff 2. Osteoporosis related fractures 3. Hypomagnesia 4. Vitamin b12 deficiency
37
What are the 6 PPIs?
1. Omeprazole 2. Pantoprazole 3. Lansoprazole 4. Dexlansoprazole 5. Esomeprazole 6. Rabeprazole
38
Which 2 PPIs may decrease the effectiveness of clopidogrel via CYP2C19?
1. Omeprazole 2. Esomeprazole
39
What are 3 H2RAs used to treat GERD?
1. Famotidine 2. Nizatidine 3. Cimetidine
40
True or false: H2RAs can be used in pregnancy if indicated
True
41
Which PPIs are available in IV formulations?
1. Pantoprazole 2. Esomeprazole
42
What drug can cause gynecomastia?
Cimetidine
43
Why do the H2RAs become less effective over time?
Induce tachyphylaxis
44
What 3 drug classes can be used for intermittent, mild heartburn without GERD?
1. Antacids 2. OTC H2 antagonists 3. OTC PPIs
45
What is the initial drug treatment for GERD?
PPI once daily for 8 weeks
46
When can you increase PPIs dose to twice daily?
If partial response is seen or nocturnal symptoms are present
47
If symptoms return, what can you use first line for maintenance therapy?
PPIs at lowest effective dose
48
What is the regimen for erosive esophagitis or severe symptoms and complications?
1. Lifestyle modifications 2. PPIs up to twice daily for 8 weeks
49
What are 7 lifestyle modifications?
1. Weight loss 2. Elevation of the head of the bed 3. Eat smaller meals more frequently 4. Avoid eating 3 hours prior to sleeping or lying down 5. Avoid foods that aggravate GERD 6. Avoid alcohol 7. Tobacco cessation
50
What patients should receive maintenance therapy?
1. Those w a symptomatic relapse of GERD following d/c of the drug 2. Those with a history of complications (Barrett’s esophagus)
51
Adding a ____ at bedtime can control breakthrough symptoms at night.
H2RA
52
True or false: H2RAs need to be taken with meals in order to block acid secretion that is triggered by histamine
False
53
Why might it be hard for patients to stop taking PPIs?
Because of rebound acid secretion caused by the PPIs
54
When should you taper PPIs?
Over 4 to 6 weeks
55
How should you taper PPIs?
1. Lower the dose 2. Extend interval to QOD then every 3rd day 3. Can give an antacid or H2RA for “off days”
56
What else can you suggest for rebound acid secretion?
Suggest switching to an H2RA and taking an antacid PRN for several weeks then d/c

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