GERD treatment

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GERD treatment
2013-02-03 16:35:19

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  1. frequency fo low-dose non RX H2 blockers
    prn and prophylaxis
  2. Standard dose H2 blocker frequency
    • BID for 6-12 weeks for mild symptoms
    • higher dose or QID for used for erosive disease (not cost effective compared to PPIs)
  3. H2 blocker MOA
    dec gastric acid secretion and gastric volume by inhibiting binding of histamine on H2 receptor of parietal cell
  4. High-dose H2 blocker treatment duration
    QID or BID for 8-12 wks
  5. indication and duration for OTC PPIs
    heartburn that happens 2 or more times a week.

    take daily (not effective for prn use)
  6. PPIs MOA
    irreversible binding to HK ATPase pumps of the parietal cells - inhibits the final step of gastric acid secretion
  7. when can complete relief of symptoms be expected in PPIs
    in about 4 days
  8. PPI freq for mild hearburn
    daily for 14 days
  9. PPI freq for symptomatic GERD
    daily for 4-8 wks
  10. PPI freq for healing erosive esophagitis
    daily or BID for 4-16 wks
  11. PPI treatment for atypical symptoms
    BID for 4 weeks initially
  12. MOA of Bethanechol
    • promotility agent
    • cholinergic stimulant
    • increases LES
    • increases esophageal clearance
  13. metoclopramide MOA
    • dopamin antagonist
    • increases LES
    • accelerates gastric emptying
  14. cisapride MOA
    • promotility
    • facilitates Ach release resulting inc in LES pressure and accelerated gastric emptying
  15. sucralfate and GERD
    limited value; similar in efficacy to H2 blockers in mild esophagitis
  16. who gets maintenance therapy in GERD?
    pts with complications like strictures, hemorrhage, Barrett's esophagus, and recurrence of residual symptoms after healing

    DOC: PPIs
  17. When do you refer the pt to the MD with GERD
    • 1. atypical symptoms
    • 2. alarm symptoms
    • 3. children under 12 yo
    • 4. failure of OTC therapy
  18. what are the atypical GERD symptoms?
    • chest pain that mimics angina
    • non allergic asthma
    • chronic cough
    • hoarseness
    • pharyngites
    • dental erosion
  19. what are alarm GERD symptoms?
    • dysphagia (difficulty swallowing)
    • odynophagia (painful swallowing)
    • unexplained weight loss
    • GI bleeding