INSTRUCTIONS Gastroesophageal reflux disease: 2021 guideline updates and clinical pearls
TEST INSTRUCTIONS
* Read the article. The test for this CE activity is to be taken online at http://www.nursingcenter.com/CE/NP. Tests can no longer be mailed or faxed.
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PROVIDER ACCREDITATION
Lippincott Professional Development will award 2.0 contact hours and 0.5 pharmacology consult hour for this continuing nursing education activity.
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Gastroesophageal reflux disease: 2021 guideline updates and clinical pearls
Learning Outcomes: Seventy-five percent of participants will be able to demonstrate competency in clinical reasoning for gastroesophageal reflux disease (GERD) based on the 2021 American College of Gastroenterology (ACG) clinical guideline updates and clinical pearls by achieving a posttest score of 70% or greater.
Learning Objectives: After reading the article and completing the posttest, the participant will be able to:
1. Describe the pathophysiology and symptoms of GERD.
2. Recognize the appropriate diagnostic process based on patient-specific factors.
3. Summarize pharmacologic and nonpharmacologic GERD management.
Posttest: Knowledge-based questions
1. The lower esophageal sphincter (LES) and the crural diaphragm make up the antireflux barrier. Factors that impede the function of this barrier lead to GERD. The most common cause of this malfunction is
a. fast gastric emptying.
b. normal crural diaphragm anatomy.
c. transient LES relaxations.
2. Heartburn and regurgitation, with or without bitter taste, are considered
a. alarm symptoms of GERD.
b. atypical or extraesophageal (EE) symptoms of GERD.
c. typical symptoms of GERD.
3. Alarm symptoms of GERD include
a. noncardiac chest pain, chronic cough, and asthma.
b. anemia, hematemesis, coffee ground emesis, black tarry stools, and weight loss.
c. laryngitis, tonsillitis, sore throat, odynophagia, and dental erosion.
4. According to the ACG guideline, which of the following is an accurate description of the gold standard for diagnosing GERD?
a. The gold standard is use of barium radiography due to its high sensitivity and specificity.
b. The gold standard is diagnosis following a failed empiric proton pump inhibitor (PPI) trial.
c. There is no gold standard; diagnosis is based on a combination of symptom history, testing, and treatment response.
5. In a patient experiencing EE symptoms of GERD without typical symptoms, rule out other potential causes of EE symptoms first, then
a. begin an 8- to 12-week trial of twice-daily PPIs.
b. start on-demand or intermittent PPI therapy.
c. perform reflux testing prior to initiating a PPI trial.
6. Nonpharmacologic lifestyle changes recommended in the 2021 ACG guideline include
a. no specific diet or lifestyle changes for patients diagnosed with GERD.
b. monitoring for and elimination of trigger foods and eating smaller meals.
c. lowering the head of the bed for sleeping and advising patients to sleep on their right side.
7. Which of the following patients could safely be transitioned to taking PPIs on an as-needed basis (on-demand or intermittent PPI therapy)?
a. patients with severe erosive esophagitis
b. patients with Barrett's esophagus
c. patients with nonerosive reflux disease
8. When PPIs are indicated, which of the following is an appropriate twice-daily dosing administration?
a. during lunch and dinner
b. 30-60 minutes before breakfast and dinner
c. 90-120 minutes before lunch and dinner
9. Which of the following surgical procedures can be effective as both an antireflux surgery as well as a weight-loss operation for patients with obesity and GERD?
a. gastric bypass
b. magnetic sphincter augmentation
c. fundoplication
10. Research previously cited in the 2013 ACG guideline found an association between long-term use of PPIs and adverse conditions. However, many cited studies were flawed. The only increased risk found with more recent high-quality research is for
a. gastric cancer.
b. enteric infections.
c. chronic kidney disease.