Condition Info - BotMed Application

ConditionName

Gastroesophageal reflux disease (GERD)

ConditionDescription

Dominant symptom is heartburn or acid regurgitation, does not include atypical manifestations

Symptoms

Epigastric pain; Heartburn; Regurgitation; Dysphagia;
Worse at night; Worse afternoon; Worse after meals (30-90 min); 

Bad taste (metallic);Chough; Hoarseness; Sore throat; 

Worse with lie down; Dyspnea; Nausea; Swallowing difficulty; 
BETTER WITH PPI;

PhysicalFindings

ClinicalTests

Endoscopy with biopsy; Sometimes pH testing; 
Sometimes manometry to r/o Diffuse Esophageal Spasm (DES);

No confirmatory test necessary;
24 h pH monitoring – most accurate test for GERD with uncommon symptoms: chest pain, chronic cough, asthma, sore throat;

When you suspect something more serious run endoscopy with biopsy: >5 y of symptoms to r/o Barrett esophagus -> cancer;

R/O cardiac origin (esp. in elderly): troponin/CK-MP; ECG;
R/O esophageal cancer (esp. with anemia, bleeding, weight loss, PPI not effective for 4-8 weeks, worsening of symptoms, risk or Barrett): endoscopy with biopsy;

RiskFactors

Obesity; 
Hiatal hernia; 
Pregnancy; 
Scleroderma; 
Alcohol; 
Smoking; 
Food: Coffee; Chocolate; Mint; Fatty food; Citric fruits; Spice food;
Drugs: TCA; Opioids; Nitro; Diazopen; Estrogen; Anticholinergic agents; BB (-lol) CCB (-pine); theophylline;

IsRedFlag

IsNPLEX

Consequence

Barrett esophagus;
Cancer;

ProgressionFromCondition

TreatmentOptions

Diet without: coffee, peppermint;
No late meal, 3 h before bedtime;
Elevate head for 6-8 inches;
Smoking, alcohol – no!
Drugs;
Eat smaller portion of the food, more often;
Weight loss;

PharmOptions

Persistent symptoms of erosive process: PPI 4-6 weeks;
Low BP, sodium reduction, relaxation, dietary modifications;

H2 blockers: ranitidine – reversibly block histamine H2 receptors to inhibit gastric acid;

WebLink

https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/gastroesophageal-reflux-disease-gerd