Gastroesophageal Reflux Disease (GERD) is a common disorder that has undergone many paradigm changes in the last 15 years. We discuss the current paradigms in the pathophysiology, diagnosis and management of GERD.
Gastroesophageal Reflux Disease (GERD) is a common disorder that has undergone many paradigm changes in the last 15 years. We discuss the current paradigms in the pathophysiology, diagnosis and management of GERD.
Acid peptic disease /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Eletro Stimulation of Lower Esophageal Sphincter on GERD treatment Manoel Galvao Neto
First in man Studies in a novel, unique and disruptive technology to surgicaly treat Reflux desease (GERD) without anatomical changes by laparoscopic implant of leads on the esophagi-gastric junction (EGJ) followed by stimulation of a pace=maker
Gastroesophageal Reflux Disease and Antireflux SurgeryHassan s1
this presentation describes the pathophysiology and presentation of gastroesophageal reflux disease. it also discusses the medical and surgical management of gastroesophageal reflux disease.. what makes this presentation unique is that it explains the short and long term effects of antireflux surgery and patient's satisfaction with this surgery with references.
GERD ( Gasrtro-esophageal reflux disease )
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.
And Case study at the end
Acid peptic disease /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Eletro Stimulation of Lower Esophageal Sphincter on GERD treatment Manoel Galvao Neto
First in man Studies in a novel, unique and disruptive technology to surgicaly treat Reflux desease (GERD) without anatomical changes by laparoscopic implant of leads on the esophagi-gastric junction (EGJ) followed by stimulation of a pace=maker
Gastroesophageal Reflux Disease and Antireflux SurgeryHassan s1
this presentation describes the pathophysiology and presentation of gastroesophageal reflux disease. it also discusses the medical and surgical management of gastroesophageal reflux disease.. what makes this presentation unique is that it explains the short and long term effects of antireflux surgery and patient's satisfaction with this surgery with references.
GERD ( Gasrtro-esophageal reflux disease )
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.
And Case study at the end
GERD is most common gastric problem in community affecting large number of people. Diagnosis and management is very simple with understanding.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Gastroesophageal Reflux Disease and Antireflux SurgeryHassan s1
this presentation describes the pathophysiology and presentaion of gastroesophageal reflux disease. It also discusses the medical and surgical management of gastroesophageal reflux disease. What makes this presentaion unique is that it also explains the short and long term effects of antireflux surgery and patient's satisfaction with surgery with references.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Overview of GERD
Definition
Symptoms or mucosal damage produced by
the abnormal reflux of gastric contents into
the esophagus
Classic symptom is frequent and
persistent heartburn
44 % of Americans experience heartburn
at least once per month
7 % have daily symptoms
3. Normal Function
Esophagus
Transports food from mouth to stomach through
peristaltic contractions
Lower esophageal sphincter (LES)
Relaxes, on swallowing, to allow food to enter
stomach and then contracts to prevent reflux
Normal to have some amount of reflux multiple
times each day (transient relaxation of LES – not
associated with swallowing)
5. Pathogenesis
3 lines of defense must be impaired for
GERD to develop
LES barrier impairment
Relaxation of LES
Low resting LES pressure
Increased gastric pressure
Decreased clearance of refluxed materials
from esophagus
Decreased esophageal mucosal resistance
8. Lines of Defense
Clearance of refluxed materials from
esophagus
Primary peristalsis from swallowing – increases
salivary flow
Secondary peristalsis from esophageal distension
Gravitational effects
Esophageal mucosal resistance
Mucus production in esophagus
Bicarbonate movement from blood to mucosa
9. Pathogenesis
Amount of esophageal damage seen
dependent on:
Composition of refluxed material
Which is worse: acid or alkaline refluxed material?
Volume of refluxed material
Length of contact time
Natural sensitivity of esophageal mucosa
Rate of gastric emptying
10. Typical Symptoms
Common symptoms most common when
pH<4
Heartburn
Belching and regurgitation
Hypersalivation
May be episodic or nocturnal
May be aggravated by meals and reclining
position
13. Barrett’s Esophagus
Highest prevalence in adult Caucasian males
Histologic change
Lower esophageal tissue begins to resemble the epithelium in
the stomach lining
Predisposes to esophageal cancer (30-60x) and
esophageal strictures (30-80% increased risk)
Odds ratio for development (compared with GERD < 1
yr.)
Patients with GERD 1-5 years – 3.0
Patients with GERD > 10 years – 6.4
More frequent, more severe, and longer-lasting the
symptoms of reflux, the > the risk of cancer
14. Warning Signs
If present, consider an endoscopy:
Dysphagia
Odynophagia
Bleeding
Unexplained weight loss
Choking
Chest pain
15. Diagnosis
Clinical symptoms and history
Presenting symptoms and associated risk
factors
Give empiric therapy and look for
improvement
Endoscopy if warning signs present
16. Refer
Chest pain
Heartburn while taking H2RAs or PPIs
Or heartburn that continues after 2 weeks of
treatment
Nocturnal heartburn symptoms
Frequent heartburn for > 3 months
GI bleeding and other warning signs
Concurrent use of NSAIDS
Pregnant or nursing
Children < 12 years old
17. Therapy Goals
Alleviate or eliminate symptoms
Diminish the frequency of recurrence and
duration of esophageal reflux
Promote healing – if mucosa is injured
Prevent complications
18. Therapy
Therapy is directed at:
Increasing LES pressure
Enhancing esophageal acid clearance
Improving gastric emptying
Protecting esophageal mucosa
Decreasing acidity of reflux
Decreasing gastric volume available to be
refluxed
19. Treatment
Three phases in treatment
Phase I: Lifestyle changes – 2 weeks
Lifestyle modifications
Patient-directed therapy with OTC medications
Phase II: Pharmacologic intervention
Standard/high-dose antisecretory therapy
Phase III: Surgical intervention
Patients who fail pharmacologic treatment or have severe
complications of GERD
LES positioned within the abdomen where it is under positive
pressure
20. Treatment Selection
Mild intermittent heartburn (Phase I)
Treat with lifestyle changes plus antacids
AND/OR low dose OTC H2-receptor
antagonists (H2RA’s) as needed
Symptomatic relief of mild to moderate
GERD (Phase II)
Treat with lifestyle changes plus standard
doses of H2RA’s for 6-12 weeks OR proton
pump inhibitors (PPI’s) for 4-8 weeks
21. Treatment Selection
Healing of erosive esophagitis or
treatment of moderate to severe GERD
(Phase II)
Lifestyle modifications plus PPI’s for 8-16
weeks OR high dose H2RA’s for 8-12
weeks
PPI’s preferred as initial choice due to more
rapid symptom relief and higher rate of healing
May also add a prokinetic/promotility agent
22. Treatment Considerations
Prokinetic agents are an alternative to
H2RA’s
Efficacy similar to prescription dose H2RA’s
Used as a single agent only in mild to
moderate, nonerosive GERD
May be more expensive and use is limited
by side effects
23. Treatment Considerations
Maintenance therapy may be needed
Large % of patients experience recurrence
within 6-12 months after D’C of therapy
Goal is to control symptoms and prevent
complications
May use antacids, PPIs or H2RAs
In patients with more severe symptoms, PPI most
effective
24. Lifestyle Modifications
Elevate the head of the bed 6-8 inches
Decrease fat intake
Smoking cessation
Avoid recumbency for at least 3 hours post-prandial
Weight loss
Limit alcohol intake
Wear loose-fitting clothing
Avoidance of aggravating foods
These changes alone may not control symptoms
26. Drug Therapy - Antacids
Antacids with or without alginic acid
Antacids increase LES pressure and do not promote
esophageal healing
Neutralize gastric acid, causing alkalinization
Alginic acid (in Gaviscon) forms a highly viscous
solution that floats on top of the gastric contents
Dose as needed – typical action – 1-3 hours
Not best choice for nocturnal symptoms because pH
suppression cannot be maintained
27. Drug Therapy - Antacids
Products: Magnesium salts, aluminum salts,
calcium carbonate, and sodium bicarbonate
Dosing: Initially 40-80 mEq prn (no more than
500-600 mEq per 24 hours)
Maalox/Mylanta 30 ml prn or PC & HS
Maalox TC/Mylanta II 15 ml prn or PC & HS
Gaviscon 2 tabs PC & HS
Tums 0.5-1 gm prn
28. Drug Therapy – H2RA’s
H2RA’s
Mainstay of treatment for mild to moderate
GERD
H2RA’s equally efficacious
Select based on pharmacokinetics, safety profile
and cost
Timing
Give in divided doses for constant gastric acid
suppression
May give at night if only nocturnal symptoms
Give before an activity that may result in reflux
symptoms
30. Drug Therapy – H2RA’s
Response to H2RA’s dependent upon:
1) Severity of disease
2) Duration of therapy
3) Dosage regimen used
Tolerance to effect develops
31. Drug Therapy - PPI’s
Proton Pump Inhibitors
Used to treat moderate to severe GERD
More effective and faster healing than H2RA’s
May be used to treat esophagitis refractory to H2RA’s
All agents effective - choose based on cost
Prilosec released OTC 2003
Use for heartburn that occurs ≥ 2 days/week
Label - Don’t use for more than 14 days
32. Drug Therapy - PPI’s
Standard dosing
Esomeprazole 20 mg qd
May 2006: FDA approved Nexium for adolescents 12-17
years for the short-term (up to 8 weeks) treatment of GERD
Lansoprazole 15-30 mg qd
Omeprazole 20 mg qd
Pantoprazole 40 mg qd
Rabeprazole 20 mg qd
Timing
Best is 30 minutes prior to breakfast
33. Drug Therapy - PPI’s
May give higher doses bid for
Patients with a partial response to standard
therapy
Patients with breakthrough symptoms
Patients with severe esophageal dysmotility
Patients with Barrett’s esophagus
Always give second dose 30 minutes prior
to evening meal
34. Drug Therapy - Prokinetics
Prokinetic Agents -- MOA
Enhances motility of smooth muscle from
esophagus through the proximal small bowel
Accelerates gastric emptying and transit of
intestinal contents from duodenum to
ileocecal valve
35. Drug Therapy - Prokinetics
Prokinetic Agents
Results of therapy
Improved gastric emptying
Enhanced tone of the lower esophageal sphincter
Stimulated esophageal peristalsis (cisapride only)
36. Prokinetic Agents - Products
Metoclopramide (Reglan)
Dopamine antagonist
Only use if motility dysfunction documented
Administer at least 30 minutes prior to meals
Dose - 10 to 15 mg AC and HS
Adverse Effects – limit use
diarrhea
CNS - drowsiness, restlessness, depression
extrapyramidal reactions – dystonia, motor restlessness,
etc.
breast tenderness
37. Prokinetic Agents - Products
Cisapride
Was removed from the market July 14,
2000 due to adverse cardiovascular
effects (i.e. ventricular arrhythmias)
Available only through an investigational
limited access program for patients who
have failed all other treatment options
38. Drug Therapy –
Mucosal Protectants
Sucralfate
Very limited value in treatment of GERD
Comparisons
Similar healing rate to H2RA in treatment of mild
esophagitis
Less effective than H2RAs in refractory
esophagitis
Only use in mildest form of GERD
39. Special Populations
Infants can experience a form of GERD
Postmeal regurgitation or small volume vomiting
Occurs due to a poorly functioning sphincter
Treatment
Supportive therapy
Diet adjustments – smaller, more frequent feedings;
thickened feedings
Postural management
H2RA’s have been used (e.g. ranitidine 2 mg/kg) and
antacids
40. Special Populations
Pregnancy
Common, due to decreased LES pressure
and increased abdominal pressure
Nearly half of all pregnant women experience
Antacids other than sodium bicarbonate
generally considered safe, but avoid chronic
high doses
41. GERD in the Elderly
In the US, 20% report acid reflux
Worldwide, 3X prevalence in > 70 yo of
patients younger than 39 yo
More likely to develop severe disease
More likely to be poorly diagnosed or
underdiagnosed
Due to atypical symptoms
Always look for medication causes
42. GERD in the elderly
Symptoms
Dysphagia
Vomiting
Weight loss
Anemia
Anorexia
Typical symptoms are less frequent
43. GERD in the Elderly
Diagnosis should always include
endoscopy
Prokinetic agents should be avoided
PPI’s are medications of choice for
acute episodes and prevention of
recurrence due to efficacy, safety, and
tolerability
Step down approach is preferred – more
clinically effective and more cost effective
44. PPIs in the Elderly
Decreased clearance with omeprazole,
lansoprazole, rabeprazole
Little effect on clearance with pantoprazole
Dosage adjustments not necessary
Pantoprazole – lower affinity for CYP450
45. Counseling Questions
Before recommending a therapy, ask:
Duration and frequency of symptoms
Quality and timing of symptoms
Use of alcohol and tobacco
Dietary choices
Medications already tried to treat symptoms
Other disease states present and medications
being used
46. Case Study
BT, a 45 year old male postal worker,
complains of heartburn 3-4 times per
month. The pain typically appears after
meals. He has tried Tums with varying
degrees of success. He would like
something “more effective.”
47. Case Study
What questions should you ask BT first?
What would cause you to refer BT to a
physician?
What type of GERD do you think BT has-
mild, moderate or severe?
What treatment should you recommend?