1. Gastroesophageal Reflux Disease (GERD)
Ernesto Garcia
Angela Gomez
Sandra Hernandez
Valerie Obarski

2. 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.

3. 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)

4. 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

5. Pathophysiology Normal GERD Esophagus →LES→ Stomach
Esophagus→ LES → Stomach→Esophagus
GERD can developed as a
consequence of the diet and
behavior.

6. 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

7. Diet and Behavior that worsen symptoms and contribute to high gastric acidity
High in fat
Caffeine containing
Alcohol
Chocolate
Peppermint
Behavior
Smoking
Obesity

8. 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

9. Other Common Procedures
Barium Radiology studies
Gastric Analysis
Bernstein Test
Urea Breath Test

10. Lab Values pH monitoring: < pH 4 = GERD Duration of longest
reflux episode.

11. 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

12. 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

13. Surgical Treatment Nissen fundoplication Most common Laparoscopically
Wraps the fundus of the stomach around lower esophagus
Partial fundoplication
Roux-en-Y gastric bypass
LINX

14. 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

15. 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)

16. 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.

17. Question One Which foods do most GERD patients need to avoid? Chicken
Caffeine
Yogurt
Kale

18. 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

19. 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

20. 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.