ASGE Annual GI Advanced Practice Provider Course (Virtual) - Day Two | April 2022-17_Evaluation of Patient with GERD

17_Evaluation of Patient with GERD - Myburgh

Pdf Summary

GERD, or Gastroesophageal Reflux Disease, is a condition characterized by symptoms such as heartburn and regurgitation. It affects approximately 10-20% of the Western population, with clinically troublesome heartburn seen in 6% of individuals. Patients with GERD often have a lower quality of life, with decreased work production and lower scores on sleep scales.<br /><br />There are two types of symptoms associated with GERD: typical and atypical. Typical symptoms include heartburn and regurgitation, while atypical symptoms include pulmonary symptoms like asthma and coughing, as well as ENT symptoms like throat clearing and hoarseness.<br /><br />The diagnosis of GERD is usually made based on clinical presentation. However, upper endoscopy may be performed in certain cases, such as when patients have alarm symptoms like bleeding, dysphagia, or unintentional weight loss. It may also be necessary to perform a follow-up endoscopy in patients with erosive esophagitis to screen for Barrett's esophagus.<br /><br />There are several management options for GERD. Empiric trial of acid suppression with proton pump inhibitors (PPIs) is a common approach, and patients should use the lowest effective dose. For those with breakthrough symptoms on PPIs, increasing the dose or considering surgery may be options. Surgery, such as a Nissen fundoplication, has a high success rate in reducing symptoms but can have side effects like dysphagia and gas bloat syndrome.<br /><br />Long-term use of PPIs carries some risks, including interaction with clopidogrel, bone fractures, C. difficile infection, pneumonia, and dementia. It is recommended to use the lowest dose of PPI needed and to periodically check creatinine, B12 levels, and magnesium levels.<br /><br />In summary, GERD is a common condition that can significantly impact a patient's quality of life. Diagnosis is usually based on clinical symptoms, and management options include acid suppression with PPIs and considering surgery for those with persistent symptoms. Long-term use of PPIs should be monitored for potential risks and side effects.

Keywords

GERD

Gastroesophageal Reflux Disease

heartburn

regurgitation

typical symptoms

atypical symptoms

upper endoscopy

diagnosis

acid suppression

PPIs