Updated: 10/24/2020

Gastroesophageal Reflux Disease (GERD)

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
4 4
0
0
0%
0%
Evidence
2 2
0
0
Snap Shot
  • A 65 year-old male presents complaining of heartburn, belching, and epigastic pain. His symptoms are aggravated by drinking coffee and eating fatty foods. His heartburn improves when he takes calcium carbonate.
Introduction
  • Symptomatic reflux of gastric contents into the esophagus
  • Transient lower esophageal spincter relaxation is the most common cause  
  • Other causes include
    • pregnancy
      • ↓ motility secondary to progesterone
    • ↑ gastric acidity
    • gastric outlet obstruction
    • ↓ esophageal motility
    • hiatal hernia
    • obesity
  • Associated with:
    • tobacco
    • alcohol
    • scleroderma
Presentation
  • Symptoms
    • heartburn 30-90 minutes after a meal
      • worse with reclining
      • improves with antacids
    • regurgitation
    • dysphagia
    • may mimic asthma/MI
    • can cause dyspepsia (epigastric discomfort that is worse with food)
Evaluation
  • Diagnosis based on history
  • Upper endoscopy 
    • should be performed if patient has longstanding symptoms
    • look for Barrett's esophagus and adenocarcinoma 
  • 24-hour intraesophageal pH monitoring
    • gold standard 
  • Manometry
    • reveals decreased LES pressure
Treatment
  • 1st line - lifestyle changes
    • don't lie down after eating
    • avoid spicy foods
    • eat small servings
  • 2nd line
    • H2 receptor antagonists (cimetidine, ranitidine) or
    • a promotility agent in patients with pathologic LES relaxation/hypotension
      • no longer as commonly used due to moderate efficacy and side effect profiles
  • 3rd line
    • proton pump inhibitors (omeprazole, lansoprazole) 
      • PPI's are often used as the best initial therapy and are both diagnostic and therapeutic
  • 4th line
    • surgical fundiplication or hiatal hernia repair
      • wrapping of stomach around GE junction
 

Please rate topic.

Average 4.5 of 12 Ratings

Questions (4)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidence (5)
Topic COMMENTS (25)
Private Note