GERD

Scope

• What is reflux & why it happens ?

• Common symptoms in adults & children?

• Atypical Symptoms

• Diagnosis

• Treatment – non pharmacological &

• Pharmacological

How common is it?Very common – 10 -20 % every month, up to 7 % every day

ACID PRODUCTION

• Parietal cells • 2 L of acidic gastric juice per day.

• 3 receptors on the parietal cell stimulate acid secretion.– Gastrin release is stimulated by food; – Acetylcholine release occurs via stimulation of the

vagus nerve by the sight, smell, and taste of food. – These 2 receptors stimulate the enterochromaffin-like

(ECL) cells to release histamine. – Histamine stimulates the generation of cAMP, which

stimulates acid production.

Clinical Features - Typical

Night time symptoms

Clinical Features – Atypical / Child

• Recurrent vomit

• Hoarse voice

• Crying after feeding

• Arching of back

• Recurrent Pneumonia, Night time cough

• Rec sinusitis & Rec ear infections !

• Dental erosions

• Angina like pain

Complications

Who is At Risk?

• Overweight

• Tight fitting clothes

• Large meals

• Smoking

Diagnosis

• CLINICAL DIAGNOSIS – typical symptoms

• Patients who do not respond to therapy– Endoscopy for assessing the mucosa for esophagitis

and Barrett’s esophagus

– Enables visualization and biopsy of the esophagealmucosa

• PillCam ESO– A camera containing capsule swallowed by the patient

– Less invasive than endoscopy and takes just 20minutes

Diagnosis

• Barium radiography

– less expensive than endoscopy

– lacks the sensitivity and specificity needed to accurately

• 24hr ambulatory pH monitoring

• Therapeutic trial - Omeprazole given empirically in standard ordouble doses

• Esophageal manometry- in any patient who is a candidate forantireflux surgery

Management – at home

Food & Medication that worsen GERD

Lifestyle modifications

GERD – Pharmacological Rx

Therapeutic Interventions

Antacids

• How do they work?

• Before meals, with meals or after meals?

• Common Side effects?

(Diarrhea, bloating, constipation)

• Drug Interactions?

• Any other indications?

What is the composition of digene?

3 delicious flavours: mint, orange and mixed fruit.Each 10 ml (2 teaspoonfuls approx.) contains:Magnesium hydroxide I.P. : 185mgSimethicone I.P. : 50mgSodium carboxymethylcellulose I.P. : 100mgDried aluminium hydroxide gel I.P. : 830mg

H2 Blockers

• Mechanism of action?

• Meal Interaction – best time to take?

• Common side effects?

(headache, diarrhea & fatigue)

• Drug Interactions?

• What are the pediatric formulation(s) available for H2 receptor blockers?

PPI

• Mech of action?

• Meal interactions?

• Common side-effects?

• Long term concerns?

• Drug Interactions?

Achieving steady state with PPIs, how much time does it take & why?

GERD in Pediatric Patients

Uncomplicated gastroesophageal reflux

– Usually resolves without incident by 12 to 18months of life, and

– Usually responds to supportive therapy

Dietary adjustments

Postural management

Thickened feedings

Smaller, more frequent feedings