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Gastroesophageal Reflux Disease (GERD) (SIGN & SYMPTOM (Bloating, Gum…

- - - - Typical Reflux Syndrome
      - Reflux Chest Pain Syndrome
    - - Reflux Esophagitis
      - Reflux Stricture
      - Barrett's Esophagus
      - Esophageal Adenocarcinoma
  - - - Reflux Cough Syndrome
      - Reflux Laryngitis Syndrome
      - Reflux Asthma Syndrome
      - Reflux Dental Erosion Syndrome
    - - Pharyngitis
      - Sinusitis
      - Idiopathic Pulmonary Fibrosis
      - Recurrent Otitis Media
- - - - Offer stronger acid relief than H-2 receptor blockers.
      - Side effects :: Headache, Diarrhea, Constipation, Abdominal pain, Fever, Flatulence,
        Nausea, Vomiting, Rash.
      - Most effective for ::
        -Short and long term management of GERD
        -Management of erosive disease.
      - Example : Omeprazole (Prilosec), Lansoprazole (Prevacid), Rabeprazole (Aciphex), and Esomeprazole (Nexium)
      - MOA :: It blocks the final step in gastric acid secretion by specific inhibition of adenosine triphosphatase (ATPase) enzyme system present on the secretory surface of the gastric parietal cell. Both basal and stimulated acid are inhibited.
    - - Reversibly inhibit histamine-2- receptor on parietal cell
      - Used:
        
        for intermittent mild-moderate symptom
        
        preventive dosing before meal or exercise
        
        higher prescription for severe symptoms or maintainance dosing
      - Prolonged use:
        Result in tolerance development and reduced efficacy (tachyphylaxis)
      - Example
        
        nizatidine (Axid)
        
        famotidine (Pepcid, Pepcid AC)
        
        cimetidine (Tagamet, Tagamet HB)
      - Common side effects
        
        constipation
        
        runny nose
        
        ringing in the ears
        
        headaches
        
        dry skin
        
        dry mouth
        
        difficulty sleeping
        
        diarrhea
    - - Neutralizing acid and raising intra gastric pH = decrease activation of pepsinogen and increased LES pressure
      - Used as:
        First - line therapy for intermittent symptoms
        Break through therapy for those on pp1/H2RA therapy
      - Calcium -, aluminium -, magnesium - based product
      - Forms a viscous layer in top of gastric content ti act as barrier ti reflux
    - - MOA of Metoclopromide :: Metoclopramide antagonizes the dopamine D2 receptors. Dopamine exerts relaxant effect on the gastrointestinal tract through binding to muscular D2 receptors.
      - Side effect :: Dizziness, Fatigue, Somnolence, Hyperprolactinemia, Drrowiness
      - Example :: Domperidone (Motilium®) Metoclopromide (Reglan®, Maxeran®)