-- Onset: ***
-- Timing: ***
-- Symptoms: *** chest pain/burning, regurg, sour taste in AM, sore throat, dysphagia, globus, cough, hoarseness
-- Red Flags: *** dysphagia, anorexia, weight loss, anemia/bleeding, iron deficiency, persistent vomiting, new age >60
-- DDx: pill esophagitis, hiatal hernia, malignancy, Schatzki ring, eosinophilic esophagitis, motility disorder, functional dyspepsia, rumination, infectious esophagitis - HSV, CMV, candida
-- PPI: *** omeprazole 20mg before AM meal for 4-8 weeks → 40mg → BID; assess at 8 weeks if can trial discontinuation, if sxs recur or Barrett’s put on maintenance PPI; if on PPI >6 months, taper 50% per week due to rebound
-- Other Meds: *** Histamine blocker (ranitidine, famotidine 10-20mg BID or qhs) for nighttime sxs PRN; can add baclofen 5-20mg and desipramine on top of PPI; OTC - antacids (Tums)
-- Lifestyle: *** avoid eating 2-3 hrs before bed, small meals, sleep with head propped, avoid triggering foods, weight loss, smoking cessation, limit caffeine and alcohol, exercise
-- EGD: *** If alarm sxs or no relief after 8 weeks of high-dose BID PPI - stop PPI for 2 weeks before EGD, get biopsies; if nothing seen → ambulatory pH monitoring (NERD, rule out functional) and barium swallow + esophageal manometry (achalasia, hypermotility, esophageal spasm)
Template coming soon!
New GERD Diagnosis - Lifestyle and PPI
Based on your symptoms, you likely have gastroesophageal reflux disease (GERD), otherwise known as heartburn or just reflux.
We recommend considering lifestyle factors to help with your reflux. These include avoiding meals within 2-3 hours of bed, and lying down shortly after eating. Certain foods and drinks can be triggering, including fatty or spicy foods, chocolate, caffeine, alcohol, or carbonated beverages. Many patients also report improved reflux symptoms after losng weight and stopping smoking.
We also recommend beginning a medicine called *** which is a proton pump inhibitor (PPI). This medicine will reduce the production of acid in your stomach that is causing your symptoms. We will plan to trial it for 4-8 weeks before re-assessing your symptoms. You should take *** 30-60 minutes before your AM meal to maximize its efficacy.
Some who take PPI medications over a long period of time can develop low magnesium levels, iron deficiency, or inflammation in their kidneys. We will periodically monitor these levels while you are taking the medicine.
Preparing for an EGD
A esophagogastroduodenoscopy (or EGD) is a procedure where a physician guides a scope down your mouth to visualize your upper gastrointestinal system (esophagus, stomach, parts of your small intestine). While there, they can take pictures and collect samples for biopsy if there is anything concerning.
If you take a PPI medicine, please stop taking it for 2 weeks before the procedure.
5-7 days before the procedure, you shoul stop taking any iron, aspirin, peptol bismol, or NSAID medicnes. The night before the procedure, do not eat any solid food after midnight, and avoid liquids 8 hours before the procedue.
Its okay to take your other medications 4 hours before the examination with small sips of clear water.
GERD is a common cause of heartburn and cough. PPI trials are sensitive for diagnosing GERD. You can start with a low dose PPI once daily for 4 weeks, then transition to higher doses or BID dosing. At 8 weeks, re-assess if the symptoms have improved and you can trial discontinuation. If the patient's symptoms recur after discontinuation, or they are diagnosed with Barrett's, the patient should remain on maintenance PPI therapy. Histamine blockers are often used for nighttime symptoms qhs and often lead to tachyphylaxis. Lifestyle changes include avoiding meals 2-3 hours before bed, sleeping with yoru head propped, losing weight, smoking cessation, and limiting alcohol and caffeine use. Alarm symptoms prompting evaluation with an EGD include no relief after a PPI trial, dyaphagia, globus sensation, anorexia, weight loss, anemia, and iron deficiency.