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  • Image not available. Esophageal gastroesophageal reflux disease (GERD) syndromes can be described as symptom based or esophageal tissue injury based.
  • Image not available. Endoscopy is used to evaluate mucosal damage from GERD and to assess for the presence of Barrett esophagus or other complications; ambulatory pH monitoring (with or without impedance monitoring) is useful for confirming GERD for patients with persistent symptoms without evidence of mucosal damage or for patients with atypical symptoms; manometry is useful for patients who are candidates for antireflux surgery and for ensuring proper placement of pH probes.
  • Image not available. The goals of GERD treatment are to alleviate symptoms, decrease the frequency of recurrent disease, promote healing of mucosal injury, and prevent complications.
  • Image not available. GERD treatment is determined by disease severity and includes lifestyle changes and patient-directed therapy, pharmacologic treatment, and antireflux surgery.
  • Image not available. Patients with typical esophageal GERD syndromes should be treated with lifestyle modifications as appropriate and a trial of empiric acid-suppression therapy. Those who do not respond to empiric therapy or who present with alarm symptoms should undergo endoscopy.
  • Image not available. Surgical intervention is a viable alternative treatment for select patients when long-term pharmacologic management is undesirable.
  • Image not available. Acid suppression is the mainstay of GERD treatment. Proton pump inhibitors provide the greatest symptom relief and the highest healing rates, especially for patients with erosive disease or moderate to severe symptoms.
  • Image not available. Many patients with GERD will relapse if treatment medication is withdrawn; so long-term maintenance treatment may be required. A proton pump inhibitor is the drug of choice for maintenance of patients with moderate to severe GERD.
  • Image not available. Patient medication profiles should be reviewed for drugs that may aggravate GERD. Patients should be monitored for adverse drug reactions and potential drug–drug interactions.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Explain the pathophysiologic mechanisms associated with gastroesophageal reflux disease (GERD).
  • 2. Distinguish between symptom-based (typical, atypical, or alarm) or esophageal tissue-based (esophagitis, strictures, Barrett’s esophagus, esophageal adenocarcinoma) esophageal GERD syndromes.
  • 3. Identify alarm symptoms that mandate further diagnostic evaluation.
  • 4. List medications or foods that can worsen the symptoms of GERD.
  • 5. Discuss the risk factors that can predispose a patient to GERD.
  • 6. Discern which diagnostic test is appropriate based on the patient’s clinical presentation.
  • 7. Describe the goals of treating a patient with GERD.
  • 8. Debate the benefits and limitations of lifestyle modifications in the treatment of GERD.
  • 9. Compare and contrast the differences between patient-directed therapy, pharmacologic therapy (with acid suppression agents), and interventional approaches to treating GERD.
  • 10. Discuss the benefits of proton pump inhibitors over H2-receptor antagonists in the treatment of moderate-to-severe GERD.
  • 11. Evaluate a patient’s medication profile for potential drug-drug or drug-food interactions.
  • 12. Monitor for potential adverse drug reactions associated with GERD therapies.
  • 13. Assess the need for maintenance therapy in a patient with GERD.
  • 14. Describe the potential options available for maintenance therapy of GERD.
  • 15. Develop a pharmaceutical care plan for ...

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