GERD ( Gastroesophageal reflux disease (GERD, reflex esophagitis)
Terms in this set (20)
What is the cause of reflux esophagitis?
Reflux esophagitis is the result of recurrent reflux of gastric contents into the distal esophagus secondary to a mechanical or functional abnormality of the lower esophageal sphincter.
What factors protect the esophagus?
Factors that protect the esophagus include: gravity, lower esophageal sphincter tone, esophageal motility, salviary flow, gastric emptying and tissue resistance.
In a minority of patients, reflux causes erosion of the esophagus that leads to Barret esophagitis. What type of tissue is replaced in the esophagus in Barret Esophagitis?
Replacement of normal squamous epithelium and metaplastic columnar epithelium, which can predispose to malignancy
What is the most common presenting feature of GERD?
Heartburn is the most common presenting feature, it generally is worse after meals and when lying down and often is relived with antiacids. Regurgitation or dysphagia may occur.
What is the difference between severe and less severe GERD?
Severe Gerd is usually due to severe impairment of the lower esophageal sphincter tone, Therefore symptoms will occur spontaneously when at rest. Whereas less severe GERD is associated with pattern of heart burn following meals but not associated with nighttime symptoms.
How is GERD commonly diagnosed?
Most commonly, GERD is diagnosed based on history of heart burn and regurgitation of gastric contents, especially if relieved by antiacids. More severe disease warrants endoscopy to confirm the diagnosis and to assess for epithelial damage.
In what case is an endoscopy warrented for the diagnosis of GERD?
An endoscopy is warrented in a patient that is 45 years or older and with a new onset of symptoms, long-standing or frequently recurring symptoms and failure to respond to therapy or symptoms indicating more severe conditions such as anemia, dysphagia or recurrent vomiting.
What else besides a mechanical malfunction of the lower esophageal sphincter can cause GERD like symptoms?
You want to make sure you consider the possibility that symptoms are caused by a myocardial ischemia. An electrocardiography (ECG) and appropriate cardiac workup should be considered.
What are some diagnostic studies often done in severe cases of GERD?
Barium swallow, esophageal manometry ( measures the function of the LES and the muscles that help it function), and ambulatory 24 hour pH monitoring may be indicated in more severe or refactory cases or when surgical intervention is planned.
What lab test do you want to do with someone with GERD?
Consider complete blood count (CBC) to evaluate for anemia if there is suspicion or evidence of esophageal bleed. you also want to do a DRE in cases such as these.
What are some lifestyle changes that can help improve the symptoms of GERD?
Lifestyle modifications should be implemented on presumptive diagnosis, with further workup if symptoms presist. Appropriate lifestyle modifications include cessation of smoking, avoidance of eating at bedtime, avoidance of large meals, avoidance of alcohol, caffeine and foods such as tomatos and fired foods that cause irritation. Raising the head of the bed is also helpful.
What type of medications are used for mild symptoms of GERD?
Antacids or alginic acid may be used for mild symptoms
What types of medication is used for symptomatic relief of Gerd?
Histamin H2 blockers ( ratinidine, cimetidine, famotidine, nizatidine)
What are some examples of Histamine H2 blockers?
Ratinidine, cimetidine, famotidine, nizatidine ( all end in -tidine)
What is the most powerful acid-suppresent anti-GERD medication?
An acid-suppresant proton pump inhibitor (PPI) is the most powerful anti-GERD medication. PPIs ( all end in -prazole ex: omeprazole, rabeprazole, esomeprazole, lansoprazole,dexlansoprazole,pantoprazole) are first line in moderate to severe gerd or in patients who are unresponsive to H2 blockers or have evidence of erosive gastritis. They bring both symptomatic relief and promote healing of eroded tissue.
In what cases are PPI (proton pump inhibitors) first line treatment?
They are first line treatment in moderate to severe Gerd or in patients who are unresponsive to H2 blockers or have evidence of erosive gastritis. They bring both symptomatic relief and promote healing of eroded tissue.
What are examples of PPI?
Anything that ends in -prazole ( omeprazole, rabeprazole, esomeprazole, lansoprazole, dexlansoprazole,pantroprazole)
What medication combination can be helpful in those who have severe nighttime symptoms?
A combination of an H2 blocker at bedtime and a PPI in the daytime may be helpful in patients with significant nighttime symptoms.
are surgical and endoscopic techniques used as a source of treatment?
Surgical and endoscopic techniques are available for refractory cases but they have not been shown to prevent complications of the disease.
What is nexium?