Case-Based Medicine Teaching Series

Acid-Related Disorders

Release Date: October 2003
Expiration Date: October 31, 2004


NEEDS STATEMENT
Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal disorders, affecting an estimated 5% to 7% of the global population. Although common, GERD often is unrecognized because its symptoms may be misunderstood and improperly treated or self-treated. GERD is generally a treatable disease; however, serious complications can result if it is not treated properly. Various methods to treat GERD effectively range from lifestyle measures to the use of medication or surgical procedures.

It is essential for clinicians who treat individuals with persistent heartburn or other chronic and recurrent symptoms of GERD to determine an accurate diagnosis and prescribe the most effective treatment available. This monograph describes a variety of cases involving GERD and illustrates the clinician’s process from patient presentation through diagnosis to treatment and management.


TARGET AUDIENCE
This educational program is intended for primary care physicians and physicians who deal with acid-related disorders.


LEARNING OBJECTIVES
At the completion of this activity, participants should be able to:
1. Describe signs and symptoms of supraesophageal gastroesophageal reflux disease (GERD) in childhood, as well as discuss management strategies.
2. Recognize the signs and symptoms of dyspepsia—both refractory and severe—and the optimal medical treatment.
3. Discuss the differences between nonerosive reflux disease (NERD), nonerosive esophageal disorders (NEEDs), and GERD.
4. Discuss the progression of GERD from erosive esophagitis to adenocarcinoma.
5. Identify risk factors for the development of gastrointestinal events associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
6. Discuss optimal management, including prophylactic therapy, of the patient on concurrent NSAID therapy.


ACCREDITATION STATEMENT
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Dannemiller Memorial Educational Foundation and McMahon Publishing Group. The Dannemiller Memorial Educational Foundation is accredited by the ACCME to provide continuing medical education for physicians.


DESIGNATION STATEMENT

The Dannemiller Memorial Educational Foundation designates this educational activity for a maximum of 3 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.



METHOD OF PARTICIPATION

This activity should take approximately 3 hour(s) to complete. The participant should, in order, read the objectives and monograph, answer the online multiple-choice post-test, and complete the answer form, registration, and evaluation. This credit is valid through October 31, 2004.

For questions regarding the content of this activity, contact Dannemiller Memorial Educational Foundation, accredited provider for this CME/CE activity, at edd@pain.com. For technical assistance, contact support@cecity.com.



DISCLOSURE OF UNLABELED USE

This educational activity contains discussion of published and/or investigational uses of prokinetic agents for the treatment of GERD in children; tricyclic antidepressants, tegaserod, alosetron, and cilansetron for the treatment of NEED; high-dose proton pump inhibitor (PPI) therapy for the treatment of erosive esophagitis; ablative therapies—thermal, chemical, or mechanical—for Barrett’s esophagus; and omeprazole, lansoprazole, buspirone, sumatriptan, domperidone, and tricyclic antidepressants for the treatment of functional dyspepsia. Some uses of these agents have not been approved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.



FACULTY
Colin W. Howden, MD
Series Editor
Professor of Medicine, Division of Gastroenterology, Northwestern University
Feinberg School of Medicine, Chicago, Illinois.
Dr. Howden has disclosed that he is a consultant for TAP Pharmaceuticals, Takeda, Novartis, Wyeth, Allergen, and Schwarz Pharma. He is on the speaker’s bureau for TAP Pharmaceuticals, AstraZeneca, Merck, Novartis, and Wyeth. Dr. Howden is an investigator for Merck and Takeda.

Benjamin D. Gold, MD
Associate Professor of Pediatrics and Microbiology, Division of Pediatric Gastro-enterology and Nutrition, Emory University School of Medicine, Atlanta, Georgia.
Dr. Gold has disclosed that he is a consultant and on the speaker’s bureau for TAP Pharmaceuticals, AstraZeneca, and Prometheus. He has received an honorarium from TAP Pharmaceuticals.

Joel H. Rubenstein, MD

Fellow, Department of Internal Medicine, Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan.
Dr. Rubenstein has no financial information to disclose.

William D. Chey, MD

Associate Professor, Department of Internal Medicine, Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan.
Dr. Chey has disclosed that he is a consultant for AstraZeneca, Janssen, and TAP Pharmaceuticals. He has received a research grant from AstraZeneca and Janssen; he is on the speaker’s bureau for TAP Pharmaceuticals.

David C. Metz, MD
Professor of Medicine, Division of Gastroenterology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Dr. Metz has disclosed he is a consultant for AstraZeneca, TAP Pharmaceuticals, and Wyeth. He is on the speaker’s bureau for AstraZeneca, TAP Pharmaceuticals, and Wyeth. Dr. Metz has received grant support from AstraZeneca, TAP Pharmaceuticals, and Wyeth.

John E. Pandolfino, MD

Assistant Professor of Medicine, Division of Gastroenterology, Northwestern University
Feinberg School of Medicine, Chicago, Illinois.
Dr. Pandolfino has disclosed that he has no financial affiliation with any pharmaceutical company.

Michael P. Jones, MD
Associate Professor of Medicine, Director, Gastroenterology and Physiology Laboratory, Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Dr. Jones has disclosed that he has no financial affiliation with any pharmaceutical company.

Mae F. Go, MD
Chief, Gastrointestinal Section, Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah.
Dr. Go has disclosed that she is on the speaker’s bureau for AstraZeneca, TAP Pharmaceuticals, Merck, Wyeth, and Janssen.

A. Mark Fendrick, MD
Professor, Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, Michigan.
Dr. Fendrick has disclosed that he is a consultant and on the speaker’s bureau for TAP Pharmaceuticals, AstraZeneca, Merck, McNeill, and Procter & Gamble.

David A. Peura, MD
Professor of Medicine, Associate Chief of Gastroenterology and Hepatology, University of Virginia Health Systems, Charlottesville, Virginia.
Dr. Peura has disclosed that he is on the speaker’s bureau for TAP Pharmaceuticals, AstraZeneca, Merck, and Wyeth.

Virender K. Sharma, MD
Associate Professor of Medicine, Mayo Clinic, Scottsdale, Arizona.
Dr. Sharma has disclosed that he on the speaker’s bureau and has received research grants from TAP Pharmaceuticals.

Jointly sponsored by the Dannemiller Memorial Educational Foundation and McMahon Publishing Group.

      
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This activity is made possible by an unrestricted educational grant from TAP Pharmaceuticals.
DISCLAIMER

The McMahon Publishing Group, New York City © 2003.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without prior permission of the copyright owner.

The use of general descriptive names, trade names, trademarks, etc, in this publication, even if they are not specially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone.

While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may have been made. The publisher makes no warranty, expressed or implied, with respect to material contained herein.

 

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