GERD E2

Question 1

What is the clinical presentation of GERD?

Answer 1

1. Substernal Burning/Pain
2. “Heartburn”

Question 2

How is GERD Diagnosed?

Answer 2

1. EGD if alarming symptoms.
2. Heartburn lasting longer than 3 months or refractory to OTC medication which is sensitive to empiric PPI treatment.

Question 3

What are lifestyle modifications for GERD?

Answer 3

1. Remain Upright After Eating
2. Weight Loss
3. Smaller, Frequent Meals
4. Don’t eat close to bedtime
5. Prop edge of bed w/ wedge foam
6. Avoid tight-fitting clothes.

Question 4

How is GERD empirically treated?

Answer 4

8 weeks of QD PPI therapy
–> Take 30 minutes before breakfast.
—> After 8 weeks stop

Question 5

If empiric therapy for GERD does not improve symptoms, what should be done?

Answer 5

1. Increase the Frequency of PPI

OR

2. Add H2RA (tachyphylaxis)

Question 6

If symptoms improve with empiric PPI therapy, what should be done?

Answer 6

Stop therapy–> If symptom resume –> Restart PPI at lowest effective dosage regimen to avoid long-term complications of PPI use.

Question 7

What are the OTC options for mild intermittent GERD symptoms?

Answer 7

Antacids
H2RAs
PPIs

Question 8

Long-Term GERD complications

Answer 8

Barretts Esophagus
Strictures
Severe Erosive Esophagitis

Question 9

What is Barrett’s Esophagus

Answer 9

Switch from squamous to columnar cells in the esophagus which are more resistant to acid. However, this metaplasia can quickly go from metaplasia to dysplasia. Furthermore, BE is a precursor to esophageal adenocarcinoma (20X increased risk).

This risk is further increased by tobacco and alcohol intake.

Question 10

Long Term PPI Complications

Answer 10

C. Diff
Gastroenteritis (only one reproduced on 4 year study)
SIBO
Pneumonia
CKD + AKI
Dementia
Myocardial Infarction

Question 11

What should be supplemented with chronic PPI therapy due to their increased bone fracture risk?

Answer 11

1000-1200 mg calcium
600-800 IU Vitamin D