Lower esophageal sphincter
Upper esophageal sphincter
Gnawing burning pain
Lower esophageal sphincter tone
IV drug use
Feeling of impending doom
Increases at nighttime and when laying down
Often relieved with antacids
Worse before meals
Worse after meals
Regurgitation or dysphagia may occur.
Hematemisis may occur.
Hoarseness, halitosis, cough, hiccupping and atypical CP are less common symptoms of reflux.
More severe disease is generally caused by severe impairment of the lower esophageal sphincter tone: occurs spontaneously when supine.
Less severe GERD is associated with a pattern of heartburn following meals, but not associated with nighttime Sx's.
Can have asymptomatic "silent reflux" that is typically noticed by a dentist due to dental decay
May cause loss of hair if nutritional needs are not adequate
Main symptom is heartburn approx 30-60 min. after meals.
Patients may also present with asthma, globus sensation, recurrent laryngitis, sore throat, acid brash, waterbrash. Reterosternal CP
Diffuse esophageal spasm
Transient LES relaxation (common GERD)
Hypotensive LES (More severe GERD)
Anatomical Disturbance of LES (Hiatal Hernia)
The lower GI
The Upper GI
The lower esophageal sphincter
The entire esophagus via endoscopy
Undigested food remniants on pillow
A history of heartburn, regurgitation of gastric contents... especially if relieved by antacids.
A person's affinity for spicy foods
Suggest lifestyle modifications: stop smoking, avoidance of eating at bedtime (6pm), avoidance of large meals, avoidance of alcohol, avoidance of irritating foods, raise the head of the bed, lose weight, posture changes.
Mild Symptomatic Tx: Anatacids or alginic acid
Mild GERD Tx: Histamine (H2 Blockers): may be used but in larger doses than for PUD. H2-blockers are the first-line treatment for mild GERD.
An Acid-suppressant proton pump inhibitor (PPI). The most powerful anti-GERD medication. PPIs are first-line Tx in moderate to severe disease or in patients who are unresponsive to H2-blockers or have evidence of erosive gastritis.
A combination of an H2 blocker at bedtime and a PPI in the daytime may be helpful in patients with significant nighttime symptoms.
Calcium channel blockers
All of the above
A & b
C & d
Avoid acidic foods
Avoid illegal drugs
Raise the head of the bed
Decrease fat intake
Peptic ulcer disease
Vocal Cord Errosion
Coughing, SOB, Hoarseness (caused by acid)
Lesions in the mouth
Longstanding symptoms requiring continuous treatment
Alkalis or acids