First line therapy in GERD is usually anacids.
Return of stomach contents back into the esophagus is GERD.
Causes heartburn, which results from the irritation of the esophagus by stomach acid, which causes inflammation to the esophageal mucosa. GERD can lead to scarring and strictures of the esophagus requiring stretching (dilating) of the esophagus.
Can get Barrett’s esophagus, which increases risk for cancer.
80% of patients with GERD have hiatal hernias.
Patient’s with asthma and COPD have higher rates for GERD
GERD is caused by an incompetent LES. Reflux of stomach contents into the esophagus occurs during relaxation of the LES. The decreased LES pressure allows gastric acid to contents to enter lower esophagus.
Reflux can happen at rest and increases with stress, lifting, straining, or bending.
Other risk factors for GERD are obesity and smoking.
Main symptom of GERD is heartburn that occurs 30-60 min PC and when a patient bends over or lies down. Relief is with antacid.
Other symptoms are: regurgitation of sour/bitter gastric content, belching, and fullness of stomach, chronic cough, chronic laryngitis, asthma, sore throat, and non-`cardiac chest pain.
Upper endoscopy with biopsy is standard diagnostic procedure for GERD.
Antacids weak base neutralizes gastric HCL acid by combining with it to form salt and water. This decreases the amount of gastric acid in the stomach raising the Ph.
Cardinal points of treatment
- Make lifestyle changes (diet, weight reduction, exercise, stop smoking, reduce stress, no alcohol, and sleep with head of bed elevated 4-6 inches with blocks)
- Pt should not self-medicate with OTC over 14 days without further evaluation.
- Changes in diet, weight reduction with H2 Blockers (Ranitidine/Zantac) are 1st line treatments for GERD
- Take 30-60 minutes prior to timing of other meds, breakfast, or evening meal.
- H2 receptor may be used as premedication before meals
- Goal of treatment is symptomatic relief and prevention of complications
- GERD is life long and requires lifestyle modifications and meds as indicated.
- Timing of antacid is important greatest effectiveness taken 30 minutes after meal. Taken properly duration of action can last 2 hrs.
- Take 1 hr. prior or 2 hours after taking other medications.
- Watch electrolytes (mg, na, and ca).
- Assess GI and renal status
- Avoid mg in patients with renal failure-causes Hypermagnesemia.
- Avoid sodium containing because of fluid retention.
- Antacids may cause constipation or diarrhea.