Gastroesophageal reflux disease ( GERD)

gastro esophageal reflux disease is an reflux disease

1. case presentation on gastro oesophageal reflux disease Submitted by : B.RAJU Pharm D 2 year 19HF1T0005 Submitted to : Dr. SRIDEVI mam

2. INTRODUCTION Gastro esophageal reflux disease .it refers to the retrograde movement of gastric content from the stomach to oesophagus Etiology Helicobacter pylori Genetic factors Smoking NSAIDS Alchol coffee

3. Clinical symptoms Gastric ulcer pain Dyspepsia Nausea Vomiting Heart burn Diagnosis UPPER ENDOSCOPY : it examines the inside of oesophagus and stomach it results when reflux is present it may detech inflammation in esophagus PROBE TEST : it identifies how long stomach acid regurgitates BIOPSY

4. Risk factors : Obesity Hital hernia Scleroderma Delayed stomach emptying Complications Adult onset asthma Esophagitis Ulcerations Barret’s esophagus

5. Treatment : Antacids :- aluminum hydroxide gel – 320 mg / hour calcium carbonate – 650 mg / hour magnesium hydroxide – 400mg / hour Proton pump inhibitors : omeprazole – 20 mg / OD lansoprazole – 15mg /OD Histamine 2 receptor blockers : nizatidine - 150-300mg famotidine – 20-40mg cimetidine 300-800mg

6. Pathophysiology Decreased lower esophageal sphincter pressure Disruption of anatomical barriers Esophageal clearance Mucosal resistance Delayed gastric emptying

7. SUBJECTIVE DATA Name : p. akhila Age : 19 Sex: female IP no : 210304001 Ward : FMW DOA: 04/03/2021 Unit : 3 O/E: pt is C/C/C C/O: pain in abdomen , burning micturition , depression PMHx : pain in abdomen , burninig sensation in stomach using tab rabee FMHX : Not significant SHx : mixed diet , appetite normal, no addictions , menstural history 5days/ month

8. Vitals signs : Temperature : 98.6F Bp: 120/80mmHg PR : 84 bpm CVS : S1 S2 + Ve RR: 18cycles / min RS : BAE + ve

9. OBJECTIVE DATA Hb 9.1gm% RBC 5.2 m/ cmm WBC 9,100cels/ cmm PLT 3.1L/c Neutrophils 62% Lymphocytes 30% Eosnophills 02% Monocytes 06% Basophills 00% blood urea 15mg/dl sr . Creatinine 0.8mg/dl ferrtin 2.1ng/ml Iron 75.6g/dl FBS 97mg/dl HEMATOLOGY BIOCHEMISTRY T3 1.67ng/ml T4 12.04 ng/ml TSH 2.56IU/ml Thyroid profile Endoscopy : LAX LES WITH GRADE II HIATUS HERNIA AND CHANGES OF SUPERFICIAL ANTRAL GASTRITIS NOTED ADVISED RUT H Pylori test : changes of colour from yellow to pink ( + ve )

10. ASSESMENT Based on subjective and objective data the patient has been diagnosed with PROVISIONAL DIAGNOSIS : panic attack of GERD with viral pyrexia FINAL DIAGNOSIS : Gastro esophageal reflux disease

11. PLAN Current drug Dose Frequency ROA Generic name Comment Tab zofer 4mg BD PO Ondansetron antiemetic Tab pan 40mg OD PO pantoprazole PPI Tab dolo 650mg TID PO paracetmol antipyretic Syp sucralfate 10ml BD PO Sucralfate Mucosal protectant Tab sompraz 7.5mg BD PO Esomeprazole PPI Syp supradyn 5ml BD PO Supradyn Electrolyte replenisher Tab mirtaz 7.5mg BD PO Mirtazipine Anti depressant

12. Pharmacist intervention No interventions has been found in the following case DRUG –DRUG interactions: Zofer and mirtaz These drugs increase the increase the risk of rare but serious condition called serotonin syndrome DRUG-FOOD interactions : Zofer – sucralfate When sucralfate is given with enteral feedings the feeding tube may become clogged and sucralfate may not work

13. Patient counselling : About disease: It is an digestive disease in which stomach acid or bile irritates the food pipe lining About Drugs : Don’t skip the medication follow the medications regularly Tab pan should be taken with empty stomach Syp sucralfate should not be taken with antacids with in half an hour of dose Tab sompraz should be taken before one hour of your meal

14. Life style modifications Maintain healthy weight Don’t lie down after meal Eat food slowly and chew the food properly Avoids foods and drinks that triggers refluxs such as oranges , onion ,spicy foods ,chocolates Elevate the head while sleeping Wear loose fitting clothing to limit pressure on the stomach

15. Reference Drugs .com ( www. Drugs.com) Comprehensive pharmacy by leon Shargel