Gastroesophageal Reflux
GASTROESOPHAGEAL REFLUX
GOR
GORD
Transient LES relaxation (TLESR) is the primary mechanism allowing reflux to occur
Hiatus hernias prevent normal augmentation of
Exacerbated by
Cough wheeze worsens
Supine position
Rx
(Glenn first line Mylanta Adult, 1-2ml, q4h)
Omeprazole (PPI: irreversibly inactivate the hydrogen/potassium ATPase enzyme system)
Ranitidine (H2 receptors antagonist, reducing gastric acid secretion from parietal cells)
Omeprazole: slower onset, less tolerance (ie diminished effect), acid rebound
Ranitidine: fast onset, tolerance develops, less acid rebound
Therefore > start with Ranitidine and omeprazole, cease ranitidine once established, restart to wean omeprazole.
GOR
GORD
Transient LES relaxation (TLESR) is the primary mechanism allowing reflux to occur
- independent of swallowing
- last >10s
- gastric distention is the main trigger
Hiatus hernias prevent normal augmentation of
Exacerbated by
- Low LES tone
- abnormal frequency of relaxation
- hiatus hernias
Cough wheeze worsens
Supine position
Rx
(Glenn first line Mylanta Adult, 1-2ml, q4h)
Omeprazole (PPI: irreversibly inactivate the hydrogen/potassium ATPase enzyme system)
Ranitidine (H2 receptors antagonist, reducing gastric acid secretion from parietal cells)
Omeprazole: slower onset, less tolerance (ie diminished effect), acid rebound
Ranitidine: fast onset, tolerance develops, less acid rebound
Therefore > start with Ranitidine and omeprazole, cease ranitidine once established, restart to wean omeprazole.