34 Reflux And Its Relation To Lung Disease
34.1 What this covers
- GERD
- Give for 4-8 weeks (4 usually, 8 if esophagitis is present), then attempt to taper to lowest possible dose.
- if no response by 4-8 weeks, consider workup to confirm dx (pH, manometry, or endoscopy)
34.2 Learning objectives
- GERD
- Give for 4-8 weeks (4 usually, 8 if esophagitis is present), then attempt to taper to lowest possible dose.
- if no response by 4-8 weeks, consider workup to confirm dx (pH, manometry, or endoscopy)
- if diagnosis confirmed, BID dosing will decrease time pH < 4, thus may be helpful.
- Don’t consider surgery if they don’t respond to PPI (won’t work)
34.3 Bottom line / summary
- 2020;324(24):2536-2547.
- doi:10.1001/jama.2020.21360
- Definition: recurrent troublesome heartburn or regurgitation OR sequalae (e.g.
- Barrett’s esophagus, esophagitis, stricture).
- Not equal to gastritis (less severe, irritation) or dyspepsia (which happens occasionally in all individuals)
34.4 Approach
- Give for 4-8 weeks (4 usually, 8 if esophagitis is present), then attempt to taper to lowest possible dose.
- if no response by 4-8 weeks, consider workup to confirm dx (pH, manometry, or endoscopy)
- if diagnosis confirmed, BID dosing will decrease time pH < 4, thus may be helpful.
- Don’t consider surgery if they don’t respond to PPI (won’t work)
34.5 Red flags / when to escalate
- TODO: List red flags that require urgent escalation.
34.6 Common pitfalls
- Don’t consider surgery if they don’t respond to PPI (won’t work)
34.7 References
- https://photos.collectednotes.com/photos/5187/9bb4fe81-6e1c-44af-9159-d53a028a3cc0
- https://photos.collectednotes.com/photos/5187/d55f1751-766d-45e9-b483-9f5bbfccdfbe
- https://photos.collectednotes.com/photos/5187/c1316cf5-1711-4d45-8ee9-bf7e421d5e6f
34.8 Source notes
34.8.1 Reflux And Its Relation To Lung Disease
35 Reflux and its relation to lung disease
35.1 GERD
Source: JAMA. 2020;324(24):2536-2547. doi:10.1001/jama.2020.21360
Definition: recurrent troublesome heartburn or regurgitation OR sequalae (e.g. Barrett’s esophagus, esophagitis, stricture).
Not equal to gastritis (less severe, irritation) or dyspepsia (which happens occasionally in all individuals)
Pathophys: normally the LES relaxes when the stomach expands to facilitate passage. If this happens to much = reflux. Hiatal hernia can predispose to this by lessening the normal curve near the LES.
Risk factors: Weight (via increased freq HH, increased abd->thor pressure gradient, and other mechs), smoking, and genetics.
Treatment: PPI 
- Give for 4-8 weeks (4 usually, 8 if esophagitis is present), then attempt to taper to lowest possible dose.
- if no response by 4-8 weeks, consider workup to confirm dx (pH, manometry, or endoscopy)
- if diagnosis confirmed, BID dosing will decrease time pH < 4, thus may be helpful.
- Don’t consider surgery if they don’t respond to PPI (won’t work)
IF symptoms are primarily not classic heartburn, consider pH probe to establish diagnosis. 
Ambulatory pH: establish if pH < 4 corresponds to symptoms. If not, may have functional heartburn (won’t respond to PPi)
