GERD/PPI/TREATMENT/MANAGMENT

2. Gastroesophageal Reflux

3. Gastroesophageal Reflux Becomes GERD when
it…..
Causes Erosive Complications
(EROSIVE GERD)
Causes troublesome symptoms in
absence of erosive complications
(Nonerosive GERD)

4. Risk factors
Conditions that can increase your risk
of GERD include:
•Obesity
•Bulging of the top of the stomach up above the
diaphragm (hiatal hernia)
•Pregnancy
•Connective tissue disorders, such as scleroderma
•Delayed stomach emptying
Factors that can aggravate acid reflux include:
•Smoking
•Eating large meals or eating late at night
•Eating certain foods (triggers) such as fatty or fried
foods
•Drinking certain beverages, such as alcohol or coffee
•Taking certain medications, such as aspirin
What Causes GERD
https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940#:~:text=Eating%20large%20meals%20or%20eating,certain%20medications%2C%20such%20as%20aspirin

5. How to differentiate GERD
from other conditions

6. Differentiating EE from Other Esophageal
Conditions

7. Erosive vs Nonerosive Reflux Disease
GERD is a condition
that develops when
the reflux of stomach
content causes
troublesome
symptoms and
complications
Erosive GERD
Endoscopic evidence of erosive findings
• Reflux Esophagitis
• Reflux stricture
• Barret Esophagus
• Adenocarcinoma
Non Erosive Reflux Disease
• Symptomatic syndrome
• No erosive findings
• Objective pathologic GERD
https://pubmed.ncbi.nlm.nih.gov/16928254/

8. Evaluating for Erosive Esophagitis or NERD

9. Nonerosive GERD
Symptoms

10. Diagnosing
GERD

13. Incomplete response to PPI Trial
EGD off PPI for > 7days
Inspect for erosive
esophagitis
Inspect for eosinophilic
esophagitis
Assess for hiatal hernia
Yadlapati R, et al Clinical gasteroenterol Hepatol 2022;20 984-994
Endoscopic Inspection

14. Inspecting Erosive Esophagitis

17. GERD
Management

18. Nonerosive GERD – Treatment Goals

19. Erosive Esophagitis – Treatment Goals

20. Lifestyle Modifications in GERD
Recommendation Target Population
Smoking Cessation Smokers
Weight Reduction Body Mass Index > 25
Avoid alcohol consumption Alcohol related symptoms
Avoid eating 3 hours before bed Nighttime symptoms
Head of Bed elevation Nighttime symptoms
Smaller, more frequent meals Postprandial symptoms

24. New Options for Acid
Suppression

25. Mechanism of Action
PCAB vs PPIs

26. Proposed Adverse Effects of Chronic PPI Therapy

27. Proposed Adverse Effects of Chronic PPI Therapy

28. Concluding Remarks
High quality upper endoscopy is
the definitive diagnostic test for
erosive esophagitis, which
should be graded according to
the LA classification
For patients with unproven
GERD, endoscopy should be
performed off PPIs ( ideally for
2-4 week)
In patients without EE or long
segment barretts esophagus,
reflux monitoring should be
performed off therapy to
objectively diagnose GERD and
before endoscopic or surgical
intervention
PPIs are the cornerstone of
pharmacologic management for
GERD
PCABs may offer several
advantages over PPIs for GERD
treatment, especially for
patients with severe EE