GERD

Question 1

What are complications of GERD?

Answer 1

• esophagitis
• stricture
• barret’s –> adenocarcinoma

Extraesophageal

• laryngitis
• cough,
• asthma

Question 2

What are typical presentations of GERD?

Answer 2

Heartburn

• retrosternal burning, often postprandial or at evening
• worse w/ fatty meals, lying down, or exertion

regurgitation

Hx of both of the above = 90% accurate for Dx

Question 3

what risk factors should you elicit on history?

Answer 3

RF
-esophagitis 2/2 NSAIDs, alendronate, tetracyclines

Medications
-CCBs, a-antagonists, prostaglandins, nitrates, sedatives

Question 4

what is diagnostic approach to GERD?

Answer 4

–empiric 8 week trail of PPI. start at 20-40mg qd and titrate to 40mg bid if no response after 2 weeks

Question 5

what are nonpharmacologic therapies for GERD

Answer 5

• avoid the following foods
• chocaolate, peppermint
• carbonated drinks
• citrus/tomato
• fatty foods/large meals

Question 6

pharmacotherapy

Answer 6

1. H2 receptor antagonist (mild/intermittent)
   - can lead to B12 deficiency and develop tolerance
   - interacts with Phenytoin and Warfarin
2. PPI (1st line moderate-severe)
   - can not be taken PRN (ineffective)
   - increased risk of CKD, hepatic encephalopathy, C.diff, CAP in long term use

Question 7

Barret’s esophagus screening

Answer 7

if > or = 2 of the following RF

• white
• male
• age >50y
• reflux symptoms
• central obesity

Question 8

Barrett esophagus surveillance if diagnosed

Answer 8

• no dysplasia: EGD q 3-5y
• low grade dysplasia: q6-12m
• high grade dysplasia: endoscopic mucosal resection