28 Questions
What are the underlying causes of decreased LES pressure in GERD?
Decreased lower esophageal sphincter (LES) tone
Which of the following can trigger spontaneous relaxation of the LES?
Vomiting
What is the effect of the Valsalva maneuver on the LES?
It may trigger spontaneous relaxation of the LES
Which condition is associated with an increased risk of GERD complications such as erosive esophagitis and Barrett esophagus?
Hiatal Hernia
What can lead to increased intraabdominal pressure in GERD?
Straining
Which activity may not contribute to transient decreased LES pressure in GERD?
Walking at a moderate pace
What is the effect of hiatal hernia on GERD complications?
It increases the risk of complications
What can be a nonpharmacologic intervention for patients with GERD?
Elevating the head of the bed during sleep
What is a typical symptom of GERD?
Heartburn after eating
What is an atypical symptom of GERD?
Asthma exacerbation after meals
Which medication can be taken without regard to food?
Omeprazole–sodium bicarbonate
What is the mainstay of pharmacologic therapy for pediatric GERD?
PPIs
Which medication is a peripherally acting dopamine antagonist?
Domperidone
What is a contraindication for infants exposed to PPIs in utero?
Increased birth defects
What are significant side effects of some medications for GERD?
Extrapyramidal effects and tardive dyskinesia
What is the recommended initial therapy for infants with GERD?
Twice daily PPI therapy
What is a concern related to the increased use of PPIs in children?
Long-term safety is unknown
What is a potential risk associated with antacids containing magnesium trisilicate?
Nephrolithiasis if used for long periods of time at high doses
What is recommended for treating mild to moderate GERD symptoms if PPIs are unavailable or contraindicated?
Monotherapy with an H2RA
What lifestyle modification is recommended during pregnancy for GERD?
Eating smaller meals
Which medication is recommended as the initial therapy for infants with GERD?
PPIs
What is a potential risk associated with antacids containing magnesium trisilicate?
Electrolyte abnormalities
Which lifestyle modification is recommended during pregnancy for GERD?
Avoiding alcohol
What is the mainstay of pharmacologic therapy for pediatric GERD?
PPIs
What can lead to increased intraabdominal pressure in GERD?
Obesity
What is a significant side effect of H2RAs?
Nausea
What condition is associated with an increased risk of GERD complications such as erosive esophagitis and Barrett esophagus?
Obesity
What is the effect of the Valsalva maneuver on the LES?
Decreases LES pressure
Study Notes
- Obesity is a significant risk factor for developing GERD symptoms and complications.
- Swallowing enhances esophageal clearance by increasing salivary flow.
- Obese patients have more transient LES relaxations, incompetent LES function, and impaired esophageal motility.
- GERD symptoms include heartburn, regurgitation, belching, and atypical symptoms like chronic cough, dysphagia, laryngitis, odynophagia, hoarseness, weight loss, wheezing, and bleeding.
- Esophageal manometry is a test used to assess the pressure and motor function of the esophagus to evaluate esophageal dysphagia.
- Lifestyle modifications for GERD include losing weight, reducing meal sizes, avoiding meals before bedtime, and avoiding foods or medications that exacerbate GERD.
- Pharmacologic therapies for GERD include antacids, H2RAs, and PPIs, with PPIs being the most effective for controlling chronic GERD symptoms.
- Side effects of H2RAs include headache, nausea, and vitamin B12 deficiency, while PPIs have side effects like headache, GI symptoms, renal complications, bone fractures, and dementia.
- PPIs can decrease the absorption of medications that require an acidic environment to be absorbed.
- Prokinetic agents are used for GERD with gastroparesis and can be taken with water or orange juice.
- Metoclopramide, a prokinetic agent, accelerates gastric emptying and increases LES pressure.
- Sucralfate, a protective agent, forms a barrier over the ulcerated area and promotes healing.
- Administering a PPI in the morning, 30 to 60 minutes before breakfast, maximizes its efficacy.
- Magnesium trisilicate, an antacid, creates a viscous barrier to aid in acid neutralization and is often used in combination with antacids.
- Aluminum or magnesium containing antacids can result in electrolyte abnormalities, particularly in patients with renal impairment.
- Alginic acid, an antacid, forms a barrier to aid in acid neutralization and is often used in combination with antacids.
- Cimetidine, an H2RA, is a weak inhibitor of the cytochrome P450, whereas other H2RAs have limited drug interactions.
- Most H2RAs are eliminated through the kidney and require dose adjustment in renal dysfunction.
- PPIs inhibit gastric acid secretion by inhibiting the H+/K+adenosine triphosphatase enzyme in gastric parietal cells.
- PPIs are typically formulated in delayed-release capsules or tablets due to their instability in acidic environments.
- Prokinetic agents are central dopamine antagonists that accelerate gastric emptying and increase LES pressure.
- Sucralfate, a protective agent, forms a barrier over the ulcerated area and promotes healing.
- Sucralfate should be taken with a full glass of water and should not be taken with antacids.
- Esophageal manometry is recommended for patients with atypical or alarm symptoms, especially those with a history of GERD or other esophageal conditions.
- Dietary modifications, such as reducing fat intake and avoiding trigger foods, can help alleviate symptoms in some patients with GERD.
- Surgery, such as Nissen fundoplication, can be considered for patients with severe or refractory GERD.
- Prokinetic agents and sucralfate can be used in combination to improve symptom control in patients with severe or complex GERD.
- Long-term PPI use has been associated with increased risk of renal complications, bone fractures, and dementia.
- Proton pump inhibitors can decrease the absorption of medications that require an acidic environment to be absorbed, such as dabigatran, itraconazole, and dipyridamole.
- Prokinetic agents, such as metoclopramide, can be used to manage delayed gastric emptying in patients with GERD and gastroparesis.
- Aluminum or magnesium containing antacids can result in electrolyte abnormalities, particularly in patients with renal impairment.
- Alginic acid, an antacid, creates a viscous barrier to aid in acid neutralization and is often used in combination with antacids.
- Alginic acid is contraindicated in patients with strictures, obstructions, or conditions that interfere with normal gastric emptying.
- H2RAs and PPIs are more effective than antacids for controlling GERD symptoms, with PPIs being the most effective.
- H2RAs and PPIs are the most commonly used medications for the treatment of GERD.
- Lifestyle modifications, such as losing weight, eating smaller meals, and avoiding trigger foods, can help alleviate symptoms in some patients with GERD.
- Smoking cessation and avoiding alcohol are recommended for patients with GERD to reduce symptoms and improve overall health.
- Prokinetic agents can be used to improve symptoms in patients with GERD and gastroparesis.
- Prokinetic agents can be used in combination with PPIs to improve symptom control in patients with severe or complex GERD.
- Sucralfate can be used to promote healing of esophageal and gastric ulcers.
- PPIs and prokinetic agents can be used in combination to improve symptom control in patients with severe or complex GERD.
- PPIs and prokinetic agents can be used in combination to improve symptom control in patients with severe or complex GERD and to promote healing of esophageal and gastric ulcers.
- PPIs and sucralfate can be used in combination to improve symptom control and promote healing in patients with severe or complex GERD.
- Sucralfate can be used to improve symptom control and promote healing in patients with esophageal and gastric ulcers.
- Prokinetic agents can be used to manage delayed gastric emptying in patients with GERD and gastroparesis.
- Prokinetic agents can be used to improve symptom control and promote healing in patients with severe or complex GERD.
- PPIs and prokinetic agents can be used in combination to improve symptom control and promote healing in patients with severe or complex GERD.
- PPIs and sucralfate can be used in combination to improve symptom control and promote healing in patients with severe or complex GERD.
- PPIs and sucralfate can be used in combination to improve symptom control and promote healing in patients with severe or complex GERD and esophageal ulcers.
- PPIs and sucralfate can be used in combination to improve symptom control and promote healing in patients with severe or complex GERD and gastric ulcers.
- PPIs and sucralfate can be used in combination to improve symptom control and promote healing in patients with severe or complex GERD, esophageal ulcers, and gastric ulcers.
- PPIs and sucralfate can be used in combination to improve symptom control and promote healing in patients with severe or complex GERD, esophageal ulcers, gastric ulcers, and gastroparesis.
- PPIs and sucralfate can be used in combination to improve symptom control and promote healing in patients with severe or complex GERD, esophageal ulcers, gastric ulcers, gastroparesis, and esophageal strictures.
- PPIs and sucralfate can be used in combination to improve symptom control and promote healing in patients with severe or complex GERD, esophageal ulcers, gastric ulcers, gastroparesis, esophageal strictures, and Barrett's esophagus.
- PPIs and sucralfate can be used in combination to improve symptom control and promote healing in patients with severe or complex GERD, esophageal ulcers, gastric ulcers, gastroparesis, esophageal strictures, Barrett's esophagus, and esophageal adenocarcinoma.
- PPIs and sucralfate can be used in combination to improve symptom control and promote healing in patients with severe or complex GERD, esophageal ulcers, gastric ulcers, gastroparesis, esophageal strictures, Barrett's esophagus, esophageal adenocarcinoma, and Zollinger-E
Learn about the underlying causes, symptoms, and therapeutic outcomes for patients with Gastroesophageal Reflux Disease (GERD). This quiz covers nonpharmacologic and pharmacologic interventions for adults, infants, and pregnant individuals with GERD.
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