Gastroesophageal Reflux Disorder - Reflux
SX | DX |
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.
The history of heartburn and regurgitation
Endoscopy with biopsies
Acid perfusion tests
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.
Antacids and alginic acid
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
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.
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
Proton Pump Inhibitors: Prilosec
(Omeprazole) 20 mg tab QD; Prevacid (Lansoprazole) 15-30 mg
cap QDOmeprazole/Prilosec 20 mg/day
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
IM March 19, 2002;136:490 (Letter)