3. Gastroesophageal Reflux Disease (GERD) Overview
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Questions and Answers

What are the two classifications of gastroesophageal reflux disease (GERD)?

  • Erosive and Non-erosive GERD (correct)
  • Severe and Mild GERD
  • Chronic and Acute GERD
  • Acidic and Alkaline GERD

    • How is the severity of GERD symptoms determined?

  • Through endoscopic examination only
  • Based on the pH level in the esophagus
  • By their impact on quality of life (correct)
  • By the frequency of episodes only

    • What is the most common endoscopic finding associated with esophageal mucosal injury?

  • Esophageal stricture
  • Barrett's esophagus
  • Reflux esophagitis (correct)
  • Esophageal varices

    • Which statement about GERD symptoms is accurate?

    <p>Symptoms can be intermittent or frequent.</p> Signup and view all the answers

    In the context of GERD, what does erosive refer to?

    <p>Mucosal tissue being damaged or ulcerated</p> Signup and view all the answers

    What characterizes Gastroesophageal reflux disease (GERD)?

    <p>Impairment of antireflux mechanisms</p> Signup and view all the answers

    Which of the following is a symptom of GERD?

    <p>Macroscopic damage to the esophagus</p> Signup and view all the answers

    What is a major factor in the pathophysiology of GERD?

    <p>Increased abdominothoracic pressure gradient</p> Signup and view all the answers

    Which region has the highest prevalence rates of GERD?

    <p>United States</p> Signup and view all the answers

    Which medication groups are used to treat GERD?

    <p>Antacids and H2R antagonists</p> Signup and view all the answers

    What is the incidence of GERD in Europe based on the provided data?

    <p>4.5 per 1000 person-year</p> Signup and view all the answers

    Which statement about the prevalence of GERD is true?

    <p>Increasing prevalence in many developing countries.</p> Signup and view all the answers

    What is a primary mechanism that can lead to GERD?

    <p>Impaired esophageal peristalsis.</p> Signup and view all the answers

    What is a primary benefit associated with the use of proton pump inhibitors (PPIs) for treating GERD?

    <p>They typically exhibit fewer side effects and sustain effects for longer periods.</p> Signup and view all the answers

    In the management of GERD, why might a prokinetic agent be considered, though often second to an acid-reducing approach?

    <p>To augment the muscular activity of the esophagus, which helps with gastric emptying.</p> Signup and view all the answers

    Why are antacids, despite being a common choice for GERD, not considered a primary solution?

    <p>They do not effectively reduce the secretion of stomach acid.</p> Signup and view all the answers

    Which factor is MOST important to consider when selecting the most appropriate GERD treatment plan?

    <p>The severity of the symptoms, the patient's age, other medical conditions, and potential drug interactions</p> Signup and view all the answers

    What is the role of regular follow-up appointments with a healthcare professional in the long-term management of GERD?

    <p>To monitor the effectiveness of the chosen treatment and make necessary adjustments.</p> Signup and view all the answers

    Which of the following medications directly inhibits the enzyme responsible for gastric acid production?

    <p>Omeprazole</p> Signup and view all the answers

    What is the primary mechanism of action for metoclopramide in treating GERD?

    <p>Increasing acetylcholine release and inhibiting dopamine receptors</p> Signup and view all the answers

    Why is cisapride not recommended for general use in treating GERD?

    <p>It has significant cardiac side effects.</p> Signup and view all the answers

    Which medication acts by neutralizing stomach acid rather than reducing its secretion?

    <p>Magnesium hydroxide</p> Signup and view all the answers

    Which of the following describes a key limitation of using magnesium hydroxide for GERD?

    <p>It provides temporary relief without affecting acid secretion.</p> Signup and view all the answers

    How do H2 receptor antagonists like cimetidine reduce stomach acid?

    <p>By blocking histamine-2 receptors in the stomach</p> Signup and view all the answers

    What is the mechanism of action of a prokinetic like cisapride?

    <p>Stimulating the release of acetylcholine, leading to increased intestinal motility</p> Signup and view all the answers

    Which medication is considered to be the most commonly prescribed for GERD?

    <p>Proton pump inhibitors (PPIs)</p> Signup and view all the answers

    Study Notes

    Gastroesophageal Reflux Disease (GERD)

    • GERD is a sensorimotor disorder linked to impaired anti-reflux mechanisms
    • It can involve changes in esophageal peristalsis, increased intragastric pressure, increased pressure gradient, or excess gastric acid secretion, though less often

    Objectives

    • Recall the definition of GERD
    • Understand the Los Angeles classification for erosive esophagitis
    • Understand the pathophysiology of GERD
    • Recognize the structure, pharmacokinetics, and pharmacodynamics of medications for GERD treatment, including antacids, H2R antagonists, PPIs, prostaglandin analogs, cholinemimetics, and dopamine antagonists

    Definition

    • GERD is a sensorimotor disorder associated with impaired normal antireflux mechanisms of lower esophageal sphincter function, and phrenicoesophageal ligament
    • GERD is characterized by changes in normal physiology, such as impaired esophageal peristalsis, increased intragastric pressure, increased abdominothoracic pressure gradient, or, less commonly, excess gastric acid secretion (Zollinger-Ellison syndrome)

    Epidemiology

    • GERD is common and its prevalence varies geographically
    • Prevalence is increasing in many developing countries
    • The USA has a prevalence of 18.1-27.8%
    • South America has a prevalence of 16.5-23%
    • Europe has a prevalence of 8.8-25.9%
    • Middle East has a prevalence of 8.7-21.2%
    • East Asian countries have a prevalence of less than 10%

    Classification

    • Erosive GERD: involves mucosal break(s)
    • Non-erosive GERD: characterized by symptoms alone without mucosal damage
    • Los Angeles classification: Grades A through D based on the extent of esophageal mucosal breaks (in erosive esophagitis)

    Symptoms

    • Typical: Heartburn (daytime or nighttime), regurgitation (daytime or nighttime), water brash (hypersalivation)
    • Atypical: Nausea, eructation (belching), slow digestion, early satiety, epigastric pain, bloating, vomiting, chest pain (precordial), respiratory symptoms(cough, wheeze), chronic rhinosinusitis, ENT symptoms (hoarseness, pharyngeal pain, globus), early awakening, nocturnal awakening, nightmares.
    • Symptoms may vary from intermittent (less than two episodes per week) to frequent (two or more episodes per week).

    Pathophysiology

    • Factors such as acid reflux characteristics, reflux acidity, longitudinal muscle contraction, and mucosal integrity influence the perception of reflux.
    • Conditions such as peripheral sensitization (TRPV1, TRPV4, TRPA1, and P2XR) and central sensitization also influence the perception of reflux
    • Other factors that promote the occurrence of reflux include obesity, and delayed gastric emptying

    Diagnosis

    • No gold standard exists
    • Recommended approaches prioritize symptom frequency and severity and assess presence of erosive esophagitis or Barrett's esophagus with upper endoscopy if available

    Treatment

    • Lifestyle Modifications (e.g., dietary avoidance, smoking cessation, weight reduction, avoidance of tight garments, avoidance of eating within 3 hours before bed, elevating head of bed)
    • Medications (e.g., antacids, H2R antagonists, PPIs, other drugs)
    • Surgical interventions (e.g., Nissen, Toupet, or other fundoplication)

    Treatment during pregnancy

    • Start with lifestyle modifications
    • When lifestyle modifications fail, use first-line agents like antacids (aluminum-, calcium-, or magnesium-containing), alginates, or sucralfate

    Proton Pump Inhibitors (PPIs)

    • Most effective for typical GERD symptoms
    • Associated with complete symptom relief in patients with erosive esophagitis
    • Dosage: Omeprazole 20 mg daily for 8-12 weeks

    Anti-emetics and Prokinetics

    • Cimetidine, metoclopramide, cisapride

    Surgical Management

    • Indications: Refractory GERD, Barret's esophagus, peptic stricture, and hiatal hernia
    • Surgical techniques: Laparoscopic, open, or robotic surgery (total or partial fundoplication)

    Other topics

    • Antacids: Magnesium Hydroxide
      • Indications: Used as an antacid or laxative, depending on the dose, for temporary relief of heartburn, upset stomach, or acid indigestion
      • Mechanism of Action: Neutralizes stomach acid by combining with H+ ions
      • Absorption: Absorbed slowly in the small intestine
      • Metabolism: Rapidly excreted in the urine; no metabolic changes
      • Toxicity: Drowsiness, flushing, electrolyte disturbances, hypermagnesemia (with high doses), including nausea, vomiting, dehydration, and hypotension
      • Drug interactions: Combining with aluminum-containing antacids, decreases absorption of some drugs (digoxin, dicoumarol, cimetidine), affects absorption of NSAIDs (ex ibuprofen)
    • H2R Antagonist: Cimetidine
      • Indications: Acid-reflux disorder (GERD), peptic ulcer disease
      • Mechanism of Action: Blocks histamine receptors on parietal cells, reducing acid production
      • Metabolism: Primarily metabolized by the liver
      • Adverse effects: Nausea, vomiting, diarrhea, excessive saliva, palpitations. Interferes with metabolism of other drugs, vitamin D metabolism and endocrine function, requiring careful consideration for other medication use
    • Dopamine Antagonist: Metoclopramide
      • Indications: Used for treating GERD, nausea, vomiting
      • Mechanism of Action: Antagonizes D2 dopamine receptors to accelerate gastric emptying and intestinal transit
      • Pharmacological effects: Promotes gastric emptying through muscle relaxation
      • Metabolism: Hepatic
      • Adverse effects: Dystonic reactions, oculogyric crisis, irritability, drowsiness, emesis, and apnea.
    • Cisapride
      • Indications: Treatment of nocturnal heartburn due to GERD
      • Mechanism of Action: 5-HT4, 3A, and 2A agonist; potassium voltage-gated channel subfamily H member 2 antagonist
      • Metabolism: Hepatic, via CYP3A4 enzyme
      • Adverse effects: Withdrawn from market due to life-threatening cardiac arrhythmias (long QT syndrome).

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    Gastroesophageal Reflux Disease (GERD) 2017 PDF

    Description

    This quiz covers the key aspects of Gastroesophageal Reflux Disease (GERD), including its definition, pathophysiology, and treatment options. Participants will explore the Los Angeles classification for erosive esophagitis and understand various medications used in GERD management. Test your knowledge on this common digestive disorder and its implications.

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