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34 Cards in this Set
- Front
- Back
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What are the categories of Non-erosive refulx disease?
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"symptomatic" GERD or endoscopy is negative for reflux disease - NO DAMAGE SEEN
Severe reflux symptoms but normal endoscopy results |
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What are the categories of erosive esophagitits?
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repeated exposure of esophagus to refluxate for prolonged periods resulting in inflammation and erosions.
can be cauesed by bisphosphanates, ASP, NSAIDs |
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What are categories of Barrett's Esophagus?
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complication of GERD
Columnar type epithelium may be a risk factor for cancer of the esophagus |
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What is the relationship between mortality and QOL?
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mortality is low but quality of life is significatly lowerd
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At what age is there increased incidence?
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40 - no gender differences
Barrett's esophagus is more frequent in males |
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What are some key factors in the pathophysiology of GERD?
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retrograde movement of gastric contents (acid) from stomach to esophagus
also; lower esophageal sphincter pressure defect (easier for gastric contents to move back up the esophagus) also increased intraabdominal pressure increases stress reflux types of foods increase relux as well: clocolate, fatty meals, oj, coffee, alcohol medications; anticholinergics, benzos, digydropyridine CCB, estrogen, EtOH |
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what is an anatomic factor affecting GERD?
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hiatal hernia
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How can esohpagel clearence affect GERD?
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normal amounts of acid produced but it is in the stomach too long and is in contact with the esophageal mucosa longer then normal
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What about mucosal resistance?
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esophagus has mucous secreting glands that contain bicarbonate and neutralizes refluxate
if defect then cellular acidicication and necrosis |
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how does gastric emptying affect GERD?
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decreased gastric emptying = increased vastric volume = GERD
associated with smoking and high fat meals |
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What is the hallmard symtom in GERD?
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heartburn
also can have water brash, belching, regurgitation usually occur after eating large, fatty meals, bending over, lying down after meal |
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what are some atypical clinical presentations of GERD?
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non-allergic asthma, chronic cough, hoarseness, pharyngitis, chest pain that mimicas angina, dental erosions
50% of pts w/ chest pain and normal ECG have GERD |
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what are some complicated presentations of GERD?
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dysphagia or odynophagia, esophageal strictures, bleeding, weight loss,
could be complications of Barretts, strictures, or cancer |
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What is the most usful tool in diagnosis?
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clinical history
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What if the pt is presenting with typical SX, how to treat?
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lifestyle modicications and acid suppressing therapy
GERD can be assumed if pt responds to therapy No need for invasive evaluation |
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Who are specific diagnostic tests reserved for?
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pts failing empiric therapy
complicated symptoms longstanding SX and at risk for Barretts esphagus |
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What is esohageal manometry?
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measures pressures across LES, esophagus, and pharynx
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What are treatment goals for GERD?
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alleviate/eliminate symptoms
decrease frequency of recurrent disease promote healing of musosa prevent complications |
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How long should lifestyle changes be tried before pharmacologic therapy is added?
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2 weeks
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what are most common lifestye change recommendations?
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lose weight
elevate head of bead - foam wedge eat smaller meals/avoid eating 3 hours before lying down -high protein, low fat meals elevate LES pressure avoid food/meds that aggravate GERD smoking cessation eliminate/decrease alcohol |
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What are good about antacids and atacid-alginic acid products?
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appropriate for mild GERD
immediate relief if used frequently step up therapy often used with other therapies |
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When are H2 receptor antagonists useful?
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effective for mild/moderate GERD
symptomatic relief of mild GERD standard dose is BID high doses may provide greater symptom relief and endoscopic healing prolonged courses of therapy frequently required |
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what H2 antagonist should not be used with warfarin?
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CIMETIDINE
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T/F PPI are supperior to H2 antagonists?
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T
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What limits the use of prokinetic agents?
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inferior efficacy
increased side effects |
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What prokinetic drug was taken off the market in 2000?
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cisapride
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What is sucralfate?
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a mucosal protectant
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what are mucosal prtectants?
MOA? |
non-absorbably aluminum salts
binds with proteins in exudates to form complex -creates viscous, paste-like adhesive substance -creates a coating that protects ulerated area take on empty stomach |
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What are some side effects of mucosal protectants?
drug interactions that decrease bioavailibility? |
constipation, nausea, dry mouth, dizziness, metallic taste
oral fluoroquinolones, digoxin, phenytoin, warfarin, give these drugs 2 hours prior |
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When is combination therapy useful?
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insufficient data to support the addition of a prokinetic aagent except in esophagitis and motor dysfunction concurrently
modest improvment with prokinetic and H2RA instead just just PPI |
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What are the reasons GERD occurs in pediatrics?
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LES is developmentally immature
LES relaxation (most common), impaired clearance of gastric acid, neurologic impairment, infant formula usually resolves by 12-18 months |
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How should one treat GERD in pediatrics?
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dietary adjustment, postural management, reassure parents
prokinetic agent + acid sppressant H2RAs - ranitidine PPI - lansoprozole FDA approved for ages 1-11 |
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How to treat GERD in elderly?
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PPI if older than 60
often present with atrypical symptoms Decreased GI motility and saliva production in many elderly pts |
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Explain parmacoeconomics of GERD?
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most expensive therapy in one that is ineffective
pt compliance, simple regimens improve compliance most cost effective strategy may be the most expensive drug |
