GERD
GERD can present typically with heartburn and acid regurgitation or atypically with indigestion, dysphagia, cough, hoarseness of voice, chest pain or wheezing.
In typical presentation treating with PPI is the initial action. In atypical or red flag symptoms then start with endoscopy to rule out cancer or Barret's esophagus. If negative then do a 24-hr acid monitoring while the patient is on PPI. In refractory GERD, offer antireflux surgery (fundoplication) which will not decrease the risk of Barrett's esophagus or adenocarcinoma.
PPIs increase the risk of hip fractures, pneumonia and enteric infections. They interfere with clopidogrel.
PPIs (--prazole group) are superior to H2 blockers (--tidine group).
GERD with high-grade dysplasia or early cancer treat with esophagectomy.
Life style modifications are essential, including diet modifications. One effective thing is head elevation with this helpful GERD pillow.
Herbs that help with GERD include chamomile, ginger and licorice.
Treatment Duration
Mild to Moderate GERD: Typically treated with proton pump inhibitors (PPIs) for 6 to 12 weeks.
Severe GERD or Erosive Esophagitis: May require longer treatment, often 8 weeks or more.
Maintenance Therapy: For patients with recurrent symptoms after stopping PPIs, long-term maintenance therapy may be necessary.
Guidelines for GERD treatment
Initial Treatment:
PPIs: Recommended as the first-line treatment. Taken once daily before a meal for 8 weeks.
Lifestyle Modifications: Weight loss, avoiding meals 2-3 hours before bedtime, elevating the head of the bed, and avoiding trigger foods.
Refractory GERD:
Optimize PPI Therapy: Ensure proper timing and dosage of PPIs.
Alternative Medications: Consider adding H2 receptor antagonists or switching to a different PPI.
Surgical and Endoscopic Options:
Antireflux Surgery: For patients with severe symptoms not controlled by medications3.
Magnetic Sphincter Augmentation: An alternative to traditional surgery for certain patients.
Long-Term Management:
Discuss Risks and Benefits: Long-term PPI use should be discussed with patients, considering potential side effects.
Regular Monitoring: Periodic reassessment to determine the need for continued therapy.
This post covers the points you need to know for your board exams as well as for teaching residents on the daily rounds. Medical professionals can't use the information here to treat their patients nor people can use the information her to treat themselves. If you are having any medical issues, contact your doctor or local emergency services.