Treatment of GERD

by Carlo Raj, MD

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    00:01 Treatment.

    00:02 So what is your next step of management with GERD, GERD, GERD? Do not change or do not administer medication.

    00:12 That is not your first step.

    00:14 Conservatively you check to see, in the stem of a question, in your vignette and with your patient, as to whether or not they have already started to implement lifestyle modifications.

    00:27 What does this mean? Stay away from tobacco.

    00:32 Do not drink alcohol, and by that because you’re having a patient that has reflux issues.

    00:39 Maybe there’s a history of this going on, quite a bit in fact.

    00:44 When you go to bed at night, do not remain in a supine position because that would then facilitate the reflux.

    00:51 So try to create an angle for yourself when you’re sleeping so that you prevent the reflux from taking place, maybe an angulation of 6 to 8 inches.

    01:01 Next , when you eat, do not make this into a race.

    01:06 So you probably… if you have GERD you probably not competing with Kobayashi or Kabashi, forget the individual but anyhow, the hotdog winner who’s always… you know what I mean? That’s amazing to me.

    01:19 I get sick just watching it but anyhow, point being is do not, do not swallow your food in a hurried, hurried fashion.

    01:28 Chew, chew, chew and slowly get it through esophagus.

    01:33 Avoid meals that lower lower esophageal sphincter pressures.

    01:38 Anti-reflux surgery if at all required.

    01:41 I’ll show you procedure coming up, mean to say that at some point, if you find that there is GERD, lifestyle modification, anti-reflux type of surgery might be indicated.

    01:53 And pro-kinetic agents, especially if you’re worried about the reflux being caused by diabetic neuropathy resulting in gastroparesis.

    02:02 So that would be the cause of why the reflux is taking place because you can’t move forward, so therefore pro-kinetics are just metochlorpramide, would then assist you and maybe perhaps even correct the GERD issues.

    02:16 Reduction of the reflux is the objective for this section.

    02:22 Reduction of acid: In the first steps of management, you do everything in your power to reduce the reflux.

    02:31 Number two, along with it, beyond the lifestyle modification, this doesn’t seem to be working or it’s not effective enough.

    02:40 Then you become a little bit more aggressive.

    02:42 The histamine blocker that you’re going to use here will be an H2 blocker, part of ranitidine, cimetidine.

    02:49 These are H2 blockers so that you prevent hopefully some of this acid from being secreted into the stomach.

    02:57 Needs at least 6 weeks of therapy.

    03:00 PPIs would be even better - Proton Pump Inhibitor; and by that you should be thinking about the parietal cell, in the fundus or the body, you’re thinking about the apical luminal membrane which is facing the lumen.

    03:13 On that membrane, you have what’s known as a hydrogen-potassium pump.

    03:17 So that’s the pump that PPIs - Prevacid, Prilosec, Nexium (the purple pill).

    03:25 Now it… all of this is available over the counter isn’t it? But it takes a little bit of time for it to work, but PPIs in fact are better acid regulators than are H2 blockers.

    03:38 Once you get through lifestyle modification.

    03:41 Once you start getting past your medication, mean to say that all of this doesn’t seem to truly be effective for your patient.

    03:49 And your patient is still exhibiting symptoms of GERD, then you’ll have to do surgery.

    03:56 On your left, before surgery, reflux taking place.

    04:01 On the right, after surgery, you’ll notice here that there is ligation taking place in which literally you secure the distal esophagus so that you do not have reflux taking place.

    04:13 So there are many mo-… many, many, many ways in which we could properly regulate and control our reflux but it begins with reflux control with lifestyle modification.

    About the Lecture

    The lecture Treatment of GERD by Carlo Raj, MD is from the course Esophageal Disease.

    Included Quiz Questions

    1. Lifestyle modification
    2. Nissen fundoplication
    3. Proton pump inhibitors like omeprazole
    4. Ranitidine
    5. Antibiotics
    1. Omeprazole for a duration of 6 weeks.
    2. Ranitidine for 6 weeks.
    3. Omeprazole and ranitidine for 6 weeks.
    4. Drugs to fix gastroparesis
    5. EKG
    1. Chest X-Ray
    2. Cessation of smoking and alcohol
    3. Proper diet and sleep routine
    4. Endoscopic evaluation
    5. Omeprazole and cimetidine

    Author of lecture Treatment of GERD

     Carlo Raj, MD

    Carlo Raj, MD

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