Exam (elaborations) NR 511 WEEK 7 ASSIGNMENT

NR 511 WEEK 7 ASSIGNMENT
Transcription for CPG GERD
Hello Dr. and Class, my name is and I will be presenting clinical practice guidelines for
Gastroesophageal reflux disease (GERD)
Slide #1
Clinical Practice Guidelines. Gastroesophageal reflux disease or GERD
Gastroesophageal reflux disease (GERD) is one of the most common diseases encountered by
the gastroenterologist and is equally as common in the primary care setting. This presentation
will provide a summary of GERD and its clinical presentation, and recommendations to
diagnosis and how to manage the disease.

Slide #2
Disease definition




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GERD defined as symptoms or complications resulting from the reflux of gastric contents into




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the esophagus or beyond, into the oral cavity (including larynx) or lung (DeVesty, & Heering,




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2018).




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Prevalence of GERD is based primarily on the typical symptoms of heartburn and regurgitation.
Estimated that 10%-20% of adults have GERD, over 8.9 million primary care visits annually. But
prevalence of GERD is unknown. It occurs most often in adults older than 40 yo. Same incidence
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between men and women. Except experienced more in women during pregnancy. Clinically
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troublesome heartburn is seen in about 6% of the population (Katz, Gerson, & Vela, 2013)
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Slide #4
Pathophysiology
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GERD is caused by the anatomical malfunction of the lower esophageal sphincter (LES) which
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is located at the bottom of the esophagus. LES is a muscle that is located at the end of the
esophagus which is responsible for peristalsis and closes to prevent acidic stomach content from
moving back to the esophagus. Esophageal reflux occurs when the gastric volume increases such
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as a large meal or the intra-abdominal pressure increases as such during pregnancy. It can also
occur when the sphincter tone of the Lower Esophageal Sphincter is decreased by the use of
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caffeine or when the Lower Esophageal Sphincter undergoes inappropriate relaxation. As the
esophagus becomes inflamed with repeated exposure to gastric acid, it cannot eliminate the
refluxed material as quickly or efficiently, prolonging the duration of the contact with each
subsequent exposure (May, Rao, Dipiro, Talbert, Yee, Matzke, Wells, Posey, 2014).
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Slide #5
Clinical Presentation
Include heartburn, regurgitation, odynophagia, dysphasia, substernal or retrosternal chest pain,
globus sensation, obesity, dental erosions, hoarseness, belching, and coughing



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, Chest pain may be a symptom of GERD, even the presenting symptom. Determining cardiac
from non-cardiac chest pain is required before considering GERD as a cause of chest pain.
Patients with non-cardiac chest pain suspected due to GERD should have diagnostic evaluation
before beginning therapy. (Conditional recommendation, moderate level of evidence). A cardiac
cause should be excluded in patients with chest pain before the beginning a GI evaluation
(Strong recommendation, low level of evidence)
The symptom of dysphagia can be associated with GERD, its presence warrants investigation for
a potential complication including an underlying motility disorder, stricture, ring, or malignancy.
Atypical symptoms including dyspepsia (persistent or recurrent pain or discomfort in the upper
abdomen/indigestion), epigastric pain, nausea, bloating, and belching may be indicative of
GERD but overlap with other conditions. There is a correlation between GERD and obesity.

Slide #6
Publication

Clinical Practice Guidelines were developed by Philip O. Katz MD, Lauren B. Gerson MD,




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MSC and Marcelo F. Vela MD, MSCR




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Published by American Journal of Gastroenterology




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The original date of publication was May 2012 and accepted December 2012.




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Online publication February 2013
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Corrigendum in 2013
I am using the 2013 version for this presentation (Katz, Gerson, Vela, 2013)
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Slide #7
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Applicability in Primary Care
GERD is one of the most common clinical conditions of the GI tract and seen in Primary Care.
Over 8.9 million primary care visits annually with GERD. The Clinical guideline is essential
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because it provides detailed evidence based guidelines in the diagnosis, management and
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treatment of GERD. The symptoms of heartburn and regurgitation are the most reliable for
making a probable diagnosis based on history alone. An 8wk PPI trial is a reasonable approach to
confirm GERD when it is suspected in patients with typical symptoms. A response to therapy
would ideally confirm the diagnosis. Potential risks with PPIs are FDA issued warnings for
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adverse cardiovascular events with Plavix users and potential risk for wrist, hip and spine
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fractures

Slide #8
Applicability in Primary Care Continued
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Diagnostic testing for GERD and utility of tests

Upper endoscopy is not required in the presence of typical GERD symptoms. (Strong
recommendation, moderate level of evidence)



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