GERD


Pathophysiology

Diagnosis

Treatment

  1. Diet adjustments
  2. Mechanical measures
  3. Antacids after meals (when symptomatic)
  4. Prokinetic agents
  5. Proton pump inhibitors-Superior to H2 blockers
  6. Surgery-Fundoplication
 
NOTE: Use of PPIs is a risk factor for Clostridium difficile-associated diarrhea


Admit Orders: GERD

1. Admit to:

2. Diagnosis: Gastroesophageal reflux disease.

3. Condition:

4. Vital Signs: q4h. Call physician if BP >160/90, <90/60; P >120, <50; T >38.5°C.

5. Activity: Up ad lib. Elevate the head of the bed by 6 inches.

6. Nursing: Guaiac stools.

7. Diet: Low-fat diet; no citrus juices or tomato products; avoid supine position after meals; no eating within 3 hours of bedtime.

8. IV Fluids: D5 ½ NS with 20 mEq KCL at TKO.

9. Special Medications:

-Pantoprazole (Protonix) 40 mg PO/IV q24h OR

-Nizatidine (Axid) 300 mg PO qhs OR

-Omeprazole (Prilosec) 20 mg PO bid (30 minutes prior to meals) OR

-Lansoprazole (Prevacid) 15-30 mg PO qd [15, 30 mg caps] OR

-Esomeprazole (Nexium) 20 or 40 mg PO qd OR

-Rabeprazole (Aciphex) 20 mg delayed-release tablet PO qd.

-Ranitidine (Zantac) 50 mg IV bolus, then continuous infusion at 12.5 mg/h (300 mg in 250 mL D5W at 11 mL/h over 24h) or 50 mg IV q8h OR

-Cimetidine (Tagamet) 300 mg IV bolus, then continuous infusion at 50 mg/h (1200 mg in 250 mL D5W over 24h) or 300 mg IV q6-8h OR

-Famotidine (Pepcid) 20 mg IV q12h.
 

10. Symptomatic Medications:

-Mylanta Plus or Maalox Plus 30 mg PO q2h prn dyspepsia.

-Trimethobenzamide (Tigan) 100-250 mg PO or 100-200 mg IM/PR q6h prn nausea OR

-Prochlorperazine (Compazine) 5-10 mg IM/IV/PO/PR q4-6h or 25 mg PR q4-6h prn nausea.
 

11. Extras: CXR, ECG, endoscopy. GI consult, surgery consult.

12. Labs: CBC, CMP, amylase, lipase, UA.