THERAPY SECTION A .pdf

HARER HEALTH SCIENCE COLLAGE DEPARTEMENT OF CLINICAL PHARMACY THRID YEAR FIRST SEMISTER SECTION A GROUP 5 SUBMITTED TO MR.CHALA D GASTROESOPHAGEL REFLUX DISEASE (GERD) 1 NEJA ABERA …………………………………O394\14 2 NEWAY FELEKE ……………………………0395\14 3 EFREM CHOKELE…………………………..0365...

HARER HEALTH SCIENCE COLLAGE DEPARTEMENT OF CLINICAL PHARMACY THRID YEAR FIRST SEMISTER SECTION A GROUP 5 SUBMITTED TO MR.CHALA D GASTROESOPHAGEL REFLUX DISEASE (GERD) 1 NEJA ABERA …………………………………O394\14 2 NEWAY FELEKE ……………………………0395\14 3 EFREM CHOKELE…………………………..0365\14 4 MEAZA MEKONNIN ……………………..0390\14 5 REMEDAN MOHAMMED ……………….400\14 6 RIYADVUSMAEL ……………………………..401\14 7 REDIET TESHOME …………………………..0398\14 8 MARTA TATEK ………………………………..0389\14 9 HANNA ENDRIS ………………………………0375\14 10 KIDIST YOHHANES…………………………..0385\14 11 HEWAN TESHOME …………………………..0372\14 12 GIRUM SOLOMON ………………………..…8372\14 13 ROBA ABDI ……………………………………0402\14 14 MESAY AYELE …………………………………….0404\14  INTRODUCTIO  EPIDEMOLOGY OF GERD  RISK FACTOR OF GERD  PATHOPHYSIOLOGY OF GERD  CLINICAL PRESENTATION OF GERD  COMPLICATION OF GERD  DIAGNOSIS METHOD OF GERD  CLASSIFICATION  GOAL OF THERAPY  NON PHARMACOLOGY MANAGEMENT  PHARMACOLOGICAL MANAGEMENT  SUMMARY  REFERENCES Gastroesophageal reflux disease (GERD) is a chronic digestive condition that occurs when stomach acid or, occasionally, stomach content flows back into the esophagus. This backflow, known as acid reflux, can irritate the lining of the esophagus and lead to a range of symptoms and complications. GERD is a common condition but can significantly affect quality of life if not properly managed. Patients experiencing recurrent or severe symptoms should consult a healthcare provider for an accurate diagnosis and tailored treatment plan. Gastroesophageal reflux disease (GERD) is influenced by various risk factors that can contribute to the development and exacerbation of the condition. Here are the primary risk factors associated with GERD: 1. Obesity 2. Dietary Factors 3. Lifestyle Choices 4. Medical Conditions 5. Age 6. Sex The pathophysiology of gastroesophageal reflux disease (GERD) involves a complex interplay of various mechanisms that result in the abnormal reflux of stomach contents into the esophagus.. Lower Esophageal Sphincter (LES) Dysfunction 2. Increased Intra-Abdominal Pressure 3. Impaired Esophageal Motility 4. Gastric Factors 5. Hiatal Hernia 6. Esophageal Mucosal Defense Mechanisms The clinical presentation of gastroesophageal reflux disease (GERD) can vary widely among individuals, but it typically includes a combination of symptoms related to esophageal irritation due to the reflux of gastric contents 1. Typical Symptoms  Heartburn: A burning sensation in the chest or throat that often occurs after eating and may worsen when lying down or bending over.  Regurgitation: The sensation of acid or undigested food coming back into the mouth or throat, which can be accompanied by a sour or bitter taste.  Dysphagia: Difficulty swallowing or a sensation of food being stuck in the throat or chest.  Chest Pain: Discomfort or pain in the chest that may mimic angina; however, it is typically related to reflux. 2. Atypical Symptoms  Chronic Cough: A persistent cough that may be worse at night or upon awakening.  Laryngitis: Inflammation of the larynx, leading to hoarseness or loss of voice.  Asthma Symptoms: Reflux can exacerbate asthma or trigger wheezing and shortness of breath.  Dental Erosion: Erosion of tooth enamel caused by chronic exposure to stomach acid.  Sore Throat: Persistent sore throat or globus sensation (feeling of a lump in the throat). 3. Severe Complications  In some cases, GERD can lead to more serious complications, including:  Esophagitis: Inflammation of the esophagus, which can cause pain, ulceration, and bleeding.  Esophageal Stricture: Narrowing of the esophagus due to scarring from chronic inflammation, leading to difficulty swallowing.  Barrett's Esophagus: A condition where the lining of the esophagus changes due to chronic acid exposure, which can increase the risk of esophageal cancer.  Respiratory Complications: Such as aspiration pneumonia or chronic bronchitis due to aspiration of refluxed material. 4. Patient History and Triggers  Patients may also report specific occurrences or factors that trigger or worsen their symptoms:  Timing of symptoms in relation to meals or body position.  Specific foods or beverages that lead to symptom exacerbation (e.g., spicy foods, alcohol, caffeine).  Lifestyle factors such as obesity or smoking that may contribute to their condition. Gastroesophageal reflux disease (GERD) can lead to several complications, particularly if the condition is chronic or left untreated. The complications of GERD can affect various parts of the gastrointestinal tract and overall health The major complications associated with GERD: 1. Esophagitis 2. Esophageal Stricture 3. Barrett's Esophagus 4. Esophageal Ulcers 5. Chronic Laryngitis Diagnosing gastroesophageal reflux disease (GERD) typically involves a combination of clinical assessment, patient history, physical examination, and sometimes specific tests 1. Patient History and Symptom Assessment Symptom Inquiry: The healthcare provider will ask about the patient's symptoms, their frequency and duration. Common symptoms include heartburn, regurgitation, difficulty swallowing, chest pain, and coughing. Lifestyle and Dietary Habits: Understanding potentially triggering foods, eating patterns, and lifestyle factors (like smoking and obesity) can provide additional insight. 2. Physical Examination A physical examination may be conducted to check for signs of complications or other underlying conditions. This can include an assessment of weight, abdominal tenderness, and other general 3. Empirical Treatment Trial A trial of proton pump inhibitors (PPIs) or H2 receptor antagonists may be initiated to see if symptoms improve. A positive response can support the diagnosis of GERD. 4. Endoscopy (Esophagogastroduodenoscopy - EGD) Direct Visualization: An endoscope is used to visually inspect the esophagus, stomach, and duodenum. This can help identify:  Inflammation (esophagitis)  Ulcers  Barrett’s esophagus  Tumors  Biopsy: During the procedure, tissue samples may be taken for histological examination if abnormalities are found. 5. Esophageal pH Monitoring This measures the acidity in the esophagus over a period of time. Techniques include:  Wireless pH Monitoring: A small capsule is attached to the esophagus during endoscopy, providing data on esophageal acid exposure.  Catheter-based pH Monitoring: A thin tube is placed through the nose into the esophagus to measure pH levels for 24 hours. 6. Esophageal Manometry This test evaluates the motility of the esophagus and the function ofthe lower esophageal sphincter (LES). It involves swallowing a small device that records pressures and contractions within the esophagus. Gastroesophageal reflux disease (GERD) can be classified based on various criteria, including symptom presentation, the presence of esophageal injury, and severity. 1. Based on Symptoms  Typical Symptoms:  Heartburn  Regurgitation  Chest pain  Dysphagia (difficulty swallowing)  Chronic cough  Hoarseness or sore throat  Atypical Symptoms:  Asthma  Dental erosions  Laryngitis  Chronic sinusitis  Globus sensation (lump in the throat) 2. Based on Esophageal Injury  ER (Erosive Reflux Disease):  Characterized by visible damage to the esophagus lining due to acid exposure. This includes:  Erosive esophagitis  Ulcers  Barrett's esophagus (a condition where the esophageal lining changes, increasing the risk of esophageal cancer)  NERD (Non-Erosive Reflux Disease):  Patients experience symptoms of GERD but do not show visible damage to the esophagus during endoscopy. This group may experience heartburn and regurgitation but have no erosions or ulcers. 3. Based on Severity  Mild GERD: Symptoms occur less than twice a week and do not disrupt daily activities significantly.  Moderate GERD: Symptoms occur more frequently, impacting daily life but are controllable with lifestyle changes and over-the-counter medications.  Severe GERD: Symptoms are persistent, frequent, and may lead to complications such as esophagitis or Barrett's esophagus, requiring prescription medications or surgical intervention. 4. Based on Complications  Complicated GERD: Involves the presence of complications like:  Esophagitis  Strictures (narrowing of the esophagus)  Barrett’s esophagus  Esophageal adenocarcinoma  Respiratory complications (like asthma)  Uncomplicated GERD: No esophageal damage or other complications are present. 5. Based on Acid Exposure  Acid GERD: Primarily characterized by excessive acid reflux, leading to typical GERD symptoms.  Non-acid GERD: Reflux episodes are present, but they may not involve acidic gastric contents, leading to atypical symptoms. The goals of therapy for gastroesophageal reflux disease (GERD) are multifaceted and aim to address the various aspects of the disease 1. Symptom Relief 2. Healing of Esophageal Mucosa 3. Prevention of Complications 4. Reduction of Acid Exposure 5. Management of Lifestyle and Dietary Factors Non-pharmacological management of gastroesophageal reflux disease (GERD) involves lifestyle modifications and dietary changes aimed at reducing symptoms and improving the patient's quality of life  Dietary Changes  Weight Management  Positioning Modifications  Avoid Certain Activities After Eating 1. Antacids  Mechanism: Neutralize stomach acid, providing quick relief from heartburn and indigestion. Examples:  Magnesium hydroxide (Maalox, Mylanta)  Aluminum hydroxide  Calcium carbonate (Tums)  Usage: Suitable for occasional heartburn relief. They are fast-acting but have a short duration of action. 2. H2-Receptor Antagonists (H2 Blockers)  Mechanism: Block histamine receptors in the stomach lining, reducing the production of gastric acid. Examples:  Ranitidine (Zantac) - Note that ranitidine has been withdrawn from most markets due to safety concerns.  Famotidine (Pepcid)  Nizatidine (Axid)  Usage: Effective for mild to moderate GERD symptoms and can be used on a scheduled or as-needed basis. 3. Proton Pump Inhibitors (PPIs)  Mechanism: Inhibit the proton pump in the stomach lining, leading to a significant and long-lasting reduction in gastric acid production. Examples:  Omeprazole (Prilosec)  Esomeprazole (Nexium)  Lansoprazole (Prevacid)  Pantoprazole (Protonix)  Usage: First-line treatment for moderate to severe GERD. Typically prescribed for an initial course of 8 weeks but may be continued long- term based on symptom control and esophageal healing. 4. Prokinetic Agents  Mechanism: Increase the motility of the gastrointestinal tract, helping to move food and acid out of the stomach more quickly. Examples:  Metoclopramide (Reglan)  Usage: Less commonly used due to side effects, but may be appropriate for certain patients, especially those with delayed gastric emptying 5. Alginate-based Preparations  Mechanism: Form a gel-like barrier that floats on top of the stomach contents, preventing reflux. Examples:  Gaviscon (contains alginate and antacid)  Usage: Provides symptomatic relief and can be helpful for individuals who prefer a non-systemic option. GERD is a manageable condition with lifestyle modifications and pharmacological treatments. Regular follow-up and individualized care are essential for effective symptom control and prevention of complications. Education on trigger foods, proper medication use, and healthy habits can greatly enhance patient outcomes and quality of life. Sharma, S. et al.: "GERD: An Overview" Inflammation Research (2015).  This article reviews the mechanisms of GERD and explores treatment options. Kahrilas, P. J., et al.: “The Esophagus” in Harrison's Principles of Internal Medicine. 20th edition. McGraw-Hill Education (2018).  An authoritative medical textbook that covers many aspects of esophageal health, including GERD. Mayo Clinic:  Provides a comprehensive overview of GERD symptoms, causes, diagnosis, and treatment options. Mayo Clinic GERD Overview Cleveland Clinic:  Offers resources and educational materials about GERD and its management. Cleveland Clinic GERD Resource