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Gastroesophageal Reflux Disease (GERD)
Ernesto Garcia Angela Gomez Sandra Hernandez Valerie Obarski
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What is GERD? Definition:
Gastroesophageal reflux disease (GERD) is defined as a condition with symptoms or complications resulting from the reflux of gastric contents into the esophagus or beyond, into the oral cavity (including the larynx) or lung.
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Epidemiology 10-20% U.S. population
Higher prevalence from years of age Global distribution of the burden of gastro-oesophageal reflux disease. Sample-size weighted mean estimates of the prevalence of at least weekly heartburn and/or regurgitation in each country. (2013)
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Symptoms Common: Complications of untreated GERD symptoms: Dysphagia
Heartburn Increased salivation Belching Bad breath Chest pain Complications of untreated GERD symptoms: Impaired swallowing Aspirations of gastric content into the lungs Ulceration Barrett’s esophagus
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Pathophysiology Normal GERD Esophagus →LES→ Stomach
Esophagus→ LES → Stomach→Esophagus GERD can developed as a consequence of the diet and behavior.
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Transient LES relaxations
Hiatal Hernia 94% of patients’ esophagitis reflux related to hiatal hernia Higher reflux severity Large contributor to Barrett’s esophagus Change in pressure Resting: Changes 5-10 mmHg Inspiration: Increases 30 mmHg Expiration: Decreases 30 mmHg Body position Others: Progesterone, CCK, Bombesin Transient LES relaxations
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Diet and Behavior that worsen symptoms and contribute to high gastric acidity
High in fat Caffeine containing Alcohol Chocolate Peppermint Behavior Smoking Obesity
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Diagnosis Diagnoses through typical signs and symptoms
Endoscopic procedure: Gastrointestinal endoscopy with biopsy Esophageal Manometry: Evaluation of the lower esophageal sphincter. pH Monitoring: 24-hour intraluminal monitoring
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Other Common Procedures
Barium Radiology studies Gastric Analysis Bernstein Test Urea Breath Test
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Lab Values pH monitoring: < pH 4 = GERD Duration of longest
reflux episode.
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Medical Treatment 3 goals in treating GERD Increase LES competence
Factors: cigarette smoking, medication use, obesity Decrease gastric acidity Medication, avoid trigger foods, consume smaller meals Improve passage of contents from the esophagus to the stomach Remain upright, lose weight, loose clothing, raise the head of the bed while sleeping
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Commonly prescribed drugs
Proton pump inhibitors Reduce acid production Prilosec, Protonix, Nexium Prokinetic agents Strengthen LES Urecholine, Reglan Foaming agents Antacid and barrier Reduce symptoms Gaviscon, Foamicon Antacids Neutralize acidity and reduce heartburn Tums, Mylanta, Alka-Seltzer, Rolaids, Pepto-Bismol Histamine blocking agents Lower acid content in stomach Pepcid AC, Zantac 75, Tagamet HB longterm use may impair calcium absorption and iron and b12 status - studies to confirm have not been completed
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Surgical Treatment Nissen fundoplication Most common Laparoscopically
Wraps the fundus of the stomach around lower esophagus Partial fundoplication Roux-en-Y gastric bypass LINX
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Complications of GERD - Barrett’s Esophagus
Caused from a change of esophageal squamous cells to columnar cells From malignant to adenocarcinoma Patients who are unresponsive to GERD treatments are more likely to develop Barrett’s Esophagus Most patients are diagnosed while have an endoscopy for GERD treatment Treatment remain the same untill, cancer develops
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Case Study Homer Simpson is a 38 y.o. Male who complains of frequent belching, regurgitation and heartburn. He considers himself a heavy drinker and spends most his nights at Moe’s Tavern drinking Duff Beef averaging 12 beers a day. His favorite food include donuts, pork chops, hamburger, hoagies, hot dogs and just about everything else. He overindulges when he eats and has almost put the The Frying Dutchman an All you Eat restaurant out of business when he continuously ate for hours after the restaurant had closed. 24 hour recall: breakfast consist of donuts, lunch include Krusty Burgers, fries and Squishees, dinner consist of ½ whole pig, bowl of mashed potatoes, 1 bowl of moosh, 2 pieces of floor pie. Homer snacks during the day on Chippos chips, Nuts & Gum, Powersauce Bar, 1 hotdog and 64 slices of cheese. Dr. Hibbert, Homer’s primary care physician, has diagnosed him with GERD and placed him on Nexium. Ht: 6’0”; Wt: 239 lbs BMI: 32.5 [Obesity class I]; IBW: 178 lbs; IBW %: 134%; ABW: 193 lbs Test: Barium X-Ray revealed relaxing of the lower esophageal sphincter Medication: Nexium 40mg one daily EER: kcal (based on Mifflin-St. Jeor) EPR: 87g of protein (based on 0.8g/kg)
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PES Statements Altered GI function related to relaxation of lower esophageal sphincter as evidence by barium x-ray results and patient complaining of heartburn. Obesity (Class I) related to high caloric intake BMI: 37.6 and 24 hour food recall. Excess alcohol intake related to overindulgence when drinking as evidence by patient stating he drinks 12 beer a day.
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Question One Which foods do most GERD patients need to avoid? Chicken
Caffeine Yogurt Kale
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Question Two 2. What test is performed in order for a patient to be diagnosed with GERD? Barium X-Ray Laboratory test Endoscopy None; diagnosis can be made based on patients signs and symptoms
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Question Three 3. In Hiatal Hernia, which is the most common cause of esophageal reflux? Changes in pressure in the stomach Relaxing of the lower esophageal sphincter Weak diaphragm Changes in esophageal squamous cells
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References GERD. (n.d.). Retrieved February 15, 2015, from Banki , M.D., F. (n.d.). Larparscopic Nissen. Retrieved February 15, 2015, from Daller, J. (2014, July 30). Diagnostic laparoscopy: MedlinePlus Medical Encyclopedia. Retrieved February 15, 2015, from Dugdale, D. (2012, November 12). Taking antacids: MedlinePlus Medical Encyclopedia. Retrieved February 17, 2015, from Gorecki, P. (2001, January 1). Gastro-esophageal reflux disease (GERD). Retrieved February 15, 2015, from Nelms, M., & Sucher, K. (2016). Nutrition therapy and pathophysiology (Third ed.). Cengage Learning. Castell, D. , Murray, J. , Tutuian, R. , Orlando, R. , & Arnold, R. (2004). Review article: The pathophysiology of gastro-oesophageal reflux disease - oesophageal manifestations. Alimentary Pharmacology & Therapeutics, 20 Suppl 9(s9), Boeckxstaens, G. (2007). Review article: The pathophysiology of gastro-oesophageal reflux disease. Alimentary Pharmacology & Therapies, 26(2), 149.
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