gastroesophageal reflux disease (gerd) ernesto garcia angela gomez sandra hernandez valerie obarski
TRANSCRIPT
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.
Symptoms
Common:• 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
Pathophysiology
NormalEsophagus →LES→ Stomach
GERD Esophagus→ LES → Stomach→Esophagus
GERD can developed as a consequence of the diet and behavior.
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
Diet and Behavior that worsen symptoms and contribute to high gastric acidity● Diet ○ High in fat○ Caffeine containing○ Alcohol○ Chocolate○ Peppermint
● Behavior○ Smoking○ Obesity
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
Other Common Procedures
• Barium Radiology studies
• Gastric Analysis
• Bernstein Test
• Urea Breath Test
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
Commonly prescribed drugs
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
Proton pump inhibitors• Reduce acid production• Prilosec, Protonix, Nexium
Prokinetic agents • Strengthen LES• Urecholine, Reglan
Foaming agents• Antacid and barrier • Reduce symptoms• Gaviscon, Foamicon
Surgical Treatment• Nissen fundoplication• Most common• Laparoscopically• Wraps the fundus of the
stomach around lower esophagus
• Partial fundoplication • Roux-en-Y gastric bypass• LINX
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
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 dailyEER: 2000-2100 kcal (based on Mifflin-St. Jeor)EPR: 87g of protein (based on 0.8g/kg)
PES Statements
1. Altered GI function related to relaxation of lower esophageal sphincter as
evidence by barium x-ray results and patient complaining of heartburn.
2. Obesity (Class I) related to high caloric intake BMI: 37.6 and 24 hour food
recall.
3. Excess alcohol intake related to overindulgence when drinking as evidence by patient stating he drinks 12 beer a day.
Question Two
2. What test is performed in order for a patient to be diagnosed with GERD?
a.Barium X-Rayb.Laboratory testc.Endoscopyd.None; diagnosis can be made based on
patients signs and symptoms
Question Three
3. In Hiatal Hernia, which is the most common cause of esophageal reflux?
a.Changes in pressure in the stomachb.Relaxing of the lower esophageal
sphincterc.Weak diaphragmd.Changes in esophageal squamous cells
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