Fast Five Quiz: Gastroesophageal Reflux Disease Management

B.S. Anand, MD


February 12, 2021

Figure 1. Gastroesophageal reflux, illustration. Chronic GERD in geriatric patients is of concern because of associations with Barrett esophagus, a condition in which the epithelium in the distal esophagus exhibits a change to columnar mucosal cells.

Patients should be advised to undertake lifestyle changes first, including elevating the head of the bed, avoiding bending over, eating smaller amounts more often, and avoiding food within 3 hours of bedtime.

Although PPIs are an important treatment option, H2-receptor antagonists are the preferred first-line pharmaceutical agents in patients whose GERD symptoms are mild to moderate and whose esophagitis is grade 1 or 2. PPIs are reserved for patients in whom GERD has been documented with objective assessment.

Dietary changes are typically advised. These changes include abstention from alcohol, chocolate, and coffee, which can lead to reflux; and from citrus, carbonated beverages, and spicy foods, which can worsen heartburn. This advice may be tailored to an individual patient's experience with symptoms. There is fair evidence that weight loss improves important outcomes.

Patients are advised to abstain from food intake before bedtime; however, appropriate liquids are permitted in this time frame.

Learn more about the management of GERD.


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