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Gastroesophageal Reflux Disorder - Reflux Esophagitis       SX  |  DX  |  RX   REF: gerd2008.pdf                            
SX:
Heartburn is the classic symptom of GERD, but associated symptoms include dysphagia, odynophagia, regurgitation, water brash, and belching. Patients describe their heartburn as a retrosternal burning pain, which also may be noted in the epigastrium, neck, throat, and occasionally the back. Frequently it occurs postprandially and is exacerbated by recumbency or bending over. 

DX:

                  

RX:

  1. Lifestyle modifications: Avoid overeating, should not eat for several hours before retiring, postural therapy (6-to-8-inch bed blocks or a bed wedge) , smoking.
  2. Antacids and alginic acid (Gaviscon®)
  3. Prokinetic drugs: bethanechol, metoclopramide, and, most recently, cisapride.
    Bethanechol works by increasing LES pressure, improving esophageal peristalsis, and increasing salivary flow, which improves esophageal acid clearance.
    Metoclopramide/Reglan 10mg ac & hs, in contrast, works primarily by improving gastric emptying.
    Cisapride 10mg qid works by increasing LES pressure, stimulating esophageal peristalsis and accelerating gastric emptying.
  4. H2 Antigonist Drugs:
    Axid (nizatidine) 150-300 mg tab bid
    Pepcid (Famotidine) 20-40 mg tab bid
    Tagamet (Cimetidine) 400-800 mg bid
    Zantac (Ranitidine) 150-300 mg tab bid
  5. Proton Pump Inhibitors: Prilosec (Omeprazole) 20 mg tab QD; Prevacid (Lansoprazole) 15-30 mg cap QDOmeprazole/Prilosec 20 mg/day
  6. Antireflux surgery: surgery should still be considered in younger patients with severe GERD who otherwise would require lifelong medical therapy. Other indications for antireflux surgery include recurrent difficult-to-dilate strictures, nonhealing ulcers, severe bleeding from esophagitis, and reflux-related complications of the respiratory tract or of the ear, nose, and throat not responding to medical therapy. The presence of Barrett's esophagus alone is not an indication for antireflux surgery.

Complications of GERD
The primary complications of GERD are peptic stricture and Barrett's esophagus with associated ulcers and risk of adenocarcinoma.

                                                                                                                                                              

A report of Sleep Apnea Rx that relieved the GERD Sx
Annals  IM  March 19, 2002;136:490 (Letter)