1. Upper GI: GERD
Group 5:
Brooke Bevins, Lindsey Gamrat, Briana McKenney, Emily Mendel, Latifah Gray, Hannah Crist

2. Patient History
Joe is a 47 YO male who came in c/o intense burning sensation in his chest accompanied by nausea. He reports that he has also been belching frequently which gives him the sensation of regurgitation in his throat.
Joe smokes ½ a pack of cigarettes per day and consumes moderate amounts of alcohol
Dx with asthma at 14 YO
Recently dx with hiatal hernia
NKA to food
Reports that he frequently get a burning sensation in chest after dinner
Late dinner then watches TV in chair and goes to bed
Symptoms worsen when he lays down
Takes antacids occasionally which helps

3. Physical and Diagnostics
Nurse calculates BMI as 31.2
A BMI over 30 indicates a patient is obese
A stool occult blood test is positive
Indicative of bleeding somewhere in the GI tract
Never had an endoscopy or acid probe test

4. Prevalence Occurs in both men and women
Most common in those that are overweight

5. Risk Factors Obesity Hiatal hernia Pregnancy Smoking Dry mouth Asthma
Diabetes
Delayed stomach emptying

6. Pathophysiology
GERD- Gastroesophageal reflux disease (aka acid-reflux disease) is caused by excessive reflux occurring, either in frequency or volume, or if the esophagus fails to contract in response to stomach contents
Common cause is a hiatal hernia
Effective diets relax the lower esophageal sphincter and don’t stimulate gastric secretions

7. Symptoms and Risks Heart burn with pain occurring behind the sternum
Pain can sometimes radiate to the neck and the back of the throat
Those at risk include pregnant women and obese people
In women, BMI may be associated with the symptoms of GERD for those who are normal or overweight.
Moderate weight gain may aggravate the symptoms
Smoking increases the risk of GERD

8. Diagnosis X-ray of esophagus Endoscopy
Chalky liquid that coats the GI tract and allows physician to see inside of tract and determine damage that has been done.
Endoscopy
Physician passes a flexible tube with a light and camera down the esophagus to view the stomach and esophagus

9. Dietary Interventions
Loose weight if it is needed
Avoid lying down for three hours after eating
Eat frequent and smaller portioned meals
Do not eat close to bed time
Stay away from food that may worsen GERD symptoms:
Citrus fruits, chocolate, caffeine, alcohol, fatty/fried foods, garlic, onions, spicy foods, tomato-based foods

10. Nursing Interventions
Educate client and family on importance of a healthy diet.
Educate client about risks attached to smoking and how it perpetuates his condition.
Promote regular exercise.
Educate client foods that are harmful to his condition.
*see dietary interventions
Assist in obtaining resources to help track nutrient/calorie intake
ChooseMyPlate.gov/SuperTracker

11. Medications
OTC: Antacids/any medicine that slows acid production and heals the esophagus
Alka-Seltzer
Prescription Strength:
H-2 receptor Blockers (Pepcid, Zantac)
Proton Pump Inhibitors (Prevacid, Prilosec)
Surgery is a last resort treatment that occurs if the medications do not help in controlling GERD

12. Alternative Medications
Not proven to treat or reverse damage, but are proven to provide some relief
Acupuncture
Relaxation Therapy
Guided Imagery
Progressive Muscle Relaxation
Herbal remedies *
Licorice, Slippery Elm, Chamomile,
Marshmallow
*May interfere with some medications

13. Patient Goals Maintains a healthy weight
Excess weight creates pressure on abdomen and acid will build up in the esophagus.
Patient avoids food and drinks causing heartburn
Fried foods, fast foods, soda, tomato sauce, onion, garlic, spicy foods, etc.
Eats smaller meals
Obese clients should work towards loosing weight and maintaining a healthier food diet.
Doesn’t lie down after eating
Wait at least three hours to lie down.

14. Outcomes Weight loss for obese clients Healthier food diet
Engage in weekly physical activities
Smaller meal portions
Stop/reduce smoking habits

15. Long-Term Implications
Narrowing of the esophagus (esophageal stricture)
An open sore in the esophagus (esophageal ulcer)
Precancerous changes to the esophagus (Barrett’s esophagus)

16. Questions?

17. References
Fennerty, Brian. (2007, May). Heartburn, gastroesophageal reflux (ger), and gastroesophageal reflux disease (gerd). Retrieved from
Longstreth, G. F. (2011, August 11). Gastroesophageal reflux disease. Retrieved from
Center for Disease Control and Prevention. (2011, September 13). About bmi for adults. Retrieved from
Mayo Foundation for Medical Education and Research (MFMER). ( ). Retrieved from home-remedies

18. References
Lutz, Carroll & Przytulski, Karen. (2011). Nutrition and Diet Therapy. Philadelphia, PA: F.A. Davis Company
Mayo Clinic Foundation for Medical Education and Research. (2011). GERD. Mayo Clinic. Retrieved from