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KEY CONCEPTS

KEY CONCEPTS

  • image Gastroesophageal reflux disease (GERD) can be described on the basis of either esophageal symptoms or esophageal tissue injury. The common symptoms include heartburn, regurgitation, chest pain, and dysphagia.

  • image Endoscopy is commonly used to evaluate mucosal injury from GERD and to assess for the presence of Barrett's esophagus or other complications, such as strictures or adenocarcinoma.

  • image Whereas ambulatory reflux monitoring only measures acid reflux, combined impedance–pH monitoring measures both acid and nonacid reflux.

  • image The goals of GERD treatment are to alleviate symptoms and improve health-related quality of life, decrease the frequency of recurrent disease, promote healing of mucosal injury, and prevent complications.

  • image GERD treatment is determined by disease severity and includes: (a) lifestyle changes and patient-directed therapy with antacids, nonprescription H2-receptor antagonists (H2RAs), and/or nonprescription proton pump inhibitors; (b) pharmacologic treatment with prescription-strength acid suppression therapy; (c) surgery; and (d) endoscopic therapies.

  • image Patients with typical GERD symptoms 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 such as dysphagia, weight loss, or gastrointestinal (GI) bleeding should undergo endoscopy.

  • image Surgical intervention is a viable alternative treatment for select patients when long-term pharmacologic management is undesirable or when patients have complications.

  • image 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 or with complications.

  • image Many patients with GERD will relapse if medication is withdrawn; so, long-term maintenance treatment may be required.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, erosive disease, or other complications such as Barrett’s esophagus.

  • image 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. Deprescribing PPIs or tapering to the lowest effective dose is a key strategy in preventing adverse effects.

BEYOND THE BOOK

BEYOND THE BOOK

Watch video entitled, “GERD” in AccessPharmacy. This ∼6-minute video summarizes the normal function of the esophagus and stomach compared to that seen with acid reflux, complications of GERD, process of acid production, and pharmacologic therapy for GERD. Students' understanding regarding the Collect, Assess, and Plan steps of the Patient Care Process are addressed with this video.

INTRODUCTION

Gastroesophageal reflux disease (GERD) is a common medical disorder.1 GERD has been described based on its physiological, functional, and symptomatic attributes.2,3 The Lyon consensus highlighted the physiological attributes of GERD, such as esophageal motor dysfunction and esophageal permeability issues. However, these abnormalities are nonspecific for GERD. The Rome IV conference described the functional syndromes with GERD characteristics. However, reflux causality cannot be made based on clinical presentation mimicking GERD.2 The Montreal consensus defines GERD as “symptoms or complications resulting ...

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