gastro esophageal reflux disease is an reflux disease

1. CASE PRESENTATION ON
GASTRO OESOPHAGEAL
REFLUX DISEASE
Submitted by : B.RAJU
Pharm D 2 year
19HF1T0005
Submitted to : Dr. SRIDEVI mam

2.  INTRODUCTION
Gastro esophageal reflux disease .it refers to the
retrograde movement of gastric content from the
stomach to oesophagus
 Etiology
• Helicobacter pylori
• Genetic factors
• Smoking
• NSAIDS
• Alchol
• coffee

4. Clinical symptoms
• Gastric ulcer pain
• Dyspepsia
• Nausea
• Vomiting
• Heart burn
 Diagnosis
I. UPPER ENDOSCOPY : it examines the inside of oesophagus
and stomach it results when reflux is present it may detech
inflammation in esophagus
II. PROBE TEST : it identifies how long stomach acid regurgitates
III. BIOPSY

5.  Risk factors :
• Obesity
• Hital hernia
• Scleroderma
• Delayed stomach emptying
 Complications
• Adult onset asthma
• Esophagitis
• Ulcerations
• Barret’s esophagus

6. Treatment :
 Antacids :- aluminum hydroxide gel – 320 mg / hour
calcium carbonate – 650 mg / hour
magnesium hydroxide – 400mg / hour
Proton pump inhibitors : omeprazole – 20 mg / OD
lansoprazole – 15mg /OD
Histamine 2 receptor blockers : nizatidine - 150-300mg
famotidine – 20-40mg
cimetidine 300-800mg

7. Pathophysiology
Decreased lower esophageal sphincter pressure
Disruption of anatomical barriers
Esophageal clearance
Mucosal resistance
Delayed gastric emptying

8. SUBJECTIVE DATA
• Name : p. akhila
• Age : 19
• Sex: female
• IP no : 210304001
• Ward : FMW
• DOA: 04/03/2021
• Unit : 3
• O/E: pt is C/C/C
• C/O: pain in abdomen , burning micturition , depression
• PMHx : pain in abdomen ,burninig sensation in stomach using tab rabee
• FMHX : Not significant
• SHx : mixed diet , appetite normal, no addictions , menstural history
5days/ month

9. Vitals signs :
Temperature : 98.6F
Bp: 120/80mmHg
PR : 84 bpm
CVS : S1 S2 +Ve
RR: 18cycles / min
RS : BAE + ve

10. OBJECTIVE DATA
Hb 9.1gm%
RBC 5.2 m/cmm
WBC 9,100cels/cmm
PLT 3.1L/c
Neutrophils 62%
Lymphocytes 30%
Eosnophills 02%
Monocytes 06%
Basophills 00%
blood urea 15mg/dl
sr . Creatinine 0.8mg/dl
ferrtin 2.1ng/ml
Iron 75.6g/dl
FBS 97mg/dl
HEMATOLOGY
BIOCHEMISTRY
T3 1.67ng/ml
T4 12.04 ng/ml
TSH 2.56IU/ml
Thyroid profile
Endoscopy : LAX LES WITH GRADE II HIATUS HERNIA AND CHANGES
OF SUPERFICIAL ANTRAL GASTRITIS NOTED ADVISED RUT
H Pylori test : changes of colour from yellow to pink ( + ve )

11. ASSESMENT
Based on subjective and objective data the patient has
been diagnosed with
 PROVISIONAL DIAGNOSIS : panic attack of
GERD with viral pyrexia
 FINAL DIAGNOSIS : Gastro esophageal reflux
disease

12. PLAN Current drug Dose Frequency ROA Generic
name
Comment
Tab zofer 4mg BD PO Ondansetron antiemetic
Tab pan 40mg OD PO pantoprazole PPI
Tab dolo 650mg TID PO paracetmol antipyretic
Syp
sucralfate
10ml BD PO Sucralfate Mucosal
protectant
Tab sompraz 7.5mg BD PO Esomeprazol
e
PPI
Syp
supradyn
5ml BD PO Supradyn Electrolyte
replenisher
Tab mirtaz 7.5mg BD PO Mirtazipine Anti
depressant

13.  Pharmacist intervention
No interventions has been found in the following
case
DRUG –DRUG interactions:
1. Zofer and mirtaz
These drugs increase the increase the risk of rare but
serious condition called serotonin syndrome
 DRUG-FOOD interactions :
1. Zofer – sucralfate
When sucralfate is given with enteral feedings the
feeding tube may become clogged and sucralfate may
not work

14. Patient counselling :
• About disease:
It is an digestive disease in which stomach acid or bile
irritates the food pipe lining
• About Drugs :
1. Don’t skip the medication follow the medications
regularly
2. Tab pan should be taken with empty stomach
3. Syp sucralfate should not be taken with antacids
with in half an hour of dose
4. Tab sompraz should be taken before one hour of
your meal

15. Life style modifications
• Maintain healthy weight
• Don’t lie down after meal
• Eat food slowly and chew the food properly
• Avoids foods and drinks that triggers refluxs such as
oranges , onion ,spicy foods ,chocolates
• Elevate the head while sleeping
• Wear loose fitting clothing to limit pressure on the stomach

16.  Reference
• Drugs .com ( www. Drugs.com)
• Comprehensive pharmacy by leon Shargel