Gastroesophageal Reflux Disease

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Information about Gastroesophageal Reflux Disease

Published on October 10, 2008

Author: pattersonby


Gastroesophageal Reflux Disease: Brooke Y. Patterson, PharmD, BCPS NU 7080: Advanced Pharmacology Research College of Nursing Gastroesophageal Reflux Disease Epidemiology: Epidemiology One of the most common medical disorders Adults and children Approximately 44% of the American population suffers from GERD symptoms at least 1X month Increases in adults over 40 years of age Pathophysiology: Pathophysiology Retrograde movement of acid from the stomach into the esophagus Lower esophageal sphincter pressure defective Anatomic factors Esophageal clearance Mucosal resistance Gastric emptying disorders Chicken or the egg? Clinical Presentation: Clinical Presentation Heartburn Regurgitation Acidic taste in mouth Chronic cough Exacerbation of asthma symptoms Sore throat Dental enamel loss Chest pain Sinusitis Diagnosis: Diagnosis Symptomology Response to treatment ACG guidelines use of omeprazole Endoscopy Gold standard Non-Pharmacologic Interventions: Non-Pharmacologic Interventions Dietary modifications Caffeine Chocolate Citrus fruits Garlic Onions Peppermint Decrease use of EtOH Reduce weight Non-Pharmacologic Interventions: Non-Pharmacologic Interventions Reduce nicotine use Elevate head of bed 6-8 inches Avoid tight fitting clothes Avoid medications that reduce LES pressure Pharmacologic Therapies: Pharmacologic Therapies Acid suppression is mainstay of treatment Antacids and OTC acid-suppressive agents are appropriate for initial patient-directed therapy PPIs provide rapid symptomatic relief and healing of esophagitis H2-antagonists are less effective Goals of therapy: Goals of therapy Reduce GERD symptoms Prevent esophageal erosion Antacids: Antacids Calcium, aluminum, and magnesium-based Mechanism of action Neutralize acid and raise intragastric pH Rapid onset of action First-line therapy for intermittent symptoms Less than 2X/week Breakthrough therapy for those on PPIs/H2-antagonists Available OTC Antacids (continued): Antacids (continued) Adverse Reactions Constipation (aluminum) Diarrhea (magnesium) Caution with renal dosing Accumulation of aluminum or magnesium Drug interactions Fluoroquinolones Tetracycline Ketoconazole Iron Histamine-2 Receptor Antagonists: Histamine-2 Receptor Antagonists Mechanism of Action Reversibly inhibit H2-receptors on the parietal cell All available OTC or prescription On-demand therapy for intermittent mild-to-moderate GERD Preventive dosing before meals or exercise Higher prescription doses are often required Less efficacious than PPIs in healing erosive esophagitis H2-Antagonists: H2-Antagonists Adverse Effects Generally well-tolerated HA Dizziness Fatigue Drug interactions MANY for cimetidine Other H2-antagonists have far fewer Proton Pump Inhibitors (PPIs): Proton Pump Inhibitors (PPIs) Drug of choice in GERD Longest duration of action of GERD agents Safest and most effective Mechanism of Action Irreversibly inhibit final step in gastric acid secretion Most costly agents Take before meals Divided dosing—give evening dose before evening meal PPIs: PPIs Adverse Effects Well tolerated HA Dizziness Nausea Diarrhea Increased risk of CAP? Adjunctive Therapies: Adjunctive Therapies Promotility agents Adjunctive therapy in refractory GERD Efficacy similar to H2-antagonists Metoclopramide 2.5-5mg PO AC and HS Bethanecol Poorly tolerated May increase gastric acid production Case: Case FM is a 27 yo with a 3-yr history of GERD. He currently takes OTC ranitidine 150mg PO BID most days (5 days/week). Slide20: Eat a third and drink a third and leave the remaining third of your stomach empty. Then, when you get angry, there will be sufficient room for your rage. -Babylonian Talmud

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