GERD Flashcards
What are FODMAPs
fermentable Oligosaccharides, disaccharides, monosaccharides and polyols
FODMAPs: F = ?
Fermentable: not absorbed in upper GIT; feeds the microflora
FODMAPs: O = ?
Oligosaccharides:
1. fructo-oligosaccharides s (fructans)
wheat, Jerusalem artichokes, globe artichokes, onions, leeks, yacon, asparagus, etc…
2. Galacatooligosaccharides (raffinose and stachyose)
legumes, cabbage, Brussel sprouts, green beans
FODMAPs: D = ?
Disaccharides,
◦ lactose (in malabsorbers)
FODMAPs: M = ?
Monosaccharides,
◦ fructose (in malabsorbers)
FODMAPs: AP = ?
And Polyols
◦ sorbitol, lactitol, xylitol, and other sugar alcohols
GERD prevalence in Western Nations
10-20%
Gerd S and S
1.Sensation of heartburn
2.Regurgitation
3.Extraoesophageal manifestations:
◦ Chronic cough
◦ Halitosis
◦ Dental erosions
◦ Chronic laryngitis
What causes GERD?
Lower oesophageal sphincter (LOS)
incompetence
Causes of GERD?
1.LES incompetence
2.delayed gastric emptying
3.impaired esophageal acid clearance
4.decreased salivation
5.presence of hiatal hernia
» reflux of gastric contents into esophagus»mucosal damage/symptoms
GERD contributing factors?
- Genetic disposition
- Medications: nitrated, CA++ channel blockers, etc.»_space; decrease LES pressure
- Smoking
- Pregnancy
- Psych stress
- Higher BMI
GERD dietary contributing factors?
- Increase acid secretion: alcohol, coffee
- Reduce LES pressure: alcohol, chocolate, coffee, fatty meals (incl nuts, seeds
- Cause transient LES relaxation: alcohol, peppermint oil
- slow gastric emptying: alcohol, fatty foods and meals
- impair esophageal motility: alcohol
- Agents capable of triggering esophageal pain: tomato/citrus juice, soft drinks, spicy foods, alcohol
OTHER: diet related factors for GERD?
- eating meals too quickly
2.consuming too large meal
3.consuming fluids with meals
4.eating close to bedtime
◦ at least 3-4 hours before bedtime - chewing food poorly
GERD: Protective Role of Helicobacter pylori?
the presence of H. pylori infection in the
stomach plays a protective role against the
development of the most severe forms and
complications of GORD (Pereira-Lima et al, 2004), including
Barrett’s oesophagus
Is GERD caused by too little gastric acid?
NO. The majority of GORD sufferers in this study had
normal HCL secretion.
Is LHBT a reliable dx tool for SIBO?
NO
LHBT =
lactose hydrogen breath test
Conventional treatment for GERD?
- PPIs = proton pump inhibitors
- H2RAs = histamine type 2 receptor antagonists
Acute adverse events with PPIs/H2RAs?
diarrhoea
nausea
abdominal pain
headaches
Longer-term risks with PPIs/H2RAs?
increased risk of gastroenteritis
SIBO
stomach bacterial overgrowth - due to decr HCL
pneumonia
spinal fracture
vitamin and mineral malabsorption - due to decr HCL
Natural Medicine Tx Aims for GERD?
Relieve symptoms
Decrease oesophageal inflammation & promote oesophageal healing
Eliminate/minimise exacerbating factors
◦ address dietary factors
◦ address lifestyle factors
Promote antioxidant defences
Improve salivary gland function/oesophageal acid clearance
Speed gastric emptying
Prevent oesophageal cancer
Support the nervous system
GERD: tools to relieve heartburn pain (which is paramount)
- GI demulcents (marshmallow, slippery Elm, licorice
- most effective in powdered form mixed with H2O (slurry) - D-limonene: may coat mucosa to protect; may promote healthy peristalsis ( speed gastric emptying)
- Melatonin
Melatonin mechanisms of action for GERD?
- inhibits nitric oxide biosynthesis» reducing rate of trnasient LES relaxation
- melatonin MT2 receptors»_space; promotes effect of ulcer healling
- MT2 receptors»_space; inhibitory action of gastric secretion
Options for GERD to Decrease oesophageal inflammation &
promote oesophageal healing?
- GI demulcents (marshmallow, slippery Elm, licorice
- most effective in powdered form mixed with H2O (slurry) - Anti-inflammatory phytomedicines for Upper GI: meadowsweet, chamomile, licorice
- Vulnerary herbal medicines: traditionally used to help heal the upper gastrointestinal tract include: Althaea officinale, Ulmus fulva,
& comfrey leaf, aloe vera, calendula flowers - Curcumin
- Given that alcohol is a common reflux exacerbating factor,teas/capsules/tablets are probably the preferred method of
administration. - Melatonin: capable of healing even severe oesophageal ulcerations
- Given the role of free radicals in reflux-induced oesophageal inflammation, the promotion of antioxidant defences is a worthwhile, but as yet, under-researched therapeutic approach
◦ brightly-coloured fruits, vegetables, and whole grains
there is no association b/w GERD and celiac disease: T or F
F: coeliac disease patients have a higher
prevalence of reflux oesophagitis (Cuomo et al,
2003)(Nachman et al, 2011)
which improves on following a strict gluten-free diet
Should GERD Avoid FODMAP Foods??
No research:
↓FODMAP diet eliminates many healthy foods
◦ many fruits
◦ many vegetables
◦ legumes
↓ FODMAP diet has negative impacts on the GIT
microbiota (Staudacher, 2012)
- best reserved for cases that don’t improve with the
other dietary & lifestyle modifications
low carb diet for GERD?
apparently found VLCD effective in reducing
GORD symptoms and reducing distal oesophageal
acid exposure
GORD is over-diagnosed in infants: T or F
True
Lifestyle changes for GERD?
Encourage weight loss
Cease smoking
Raise bed-head (20-30 cm)
How to prevent esophageal cancer?
◦ Promote antioxidant defences
patients with Barrett’s esophagus have lower plasma concentrations of
antioxidants (selenium, vitamin C, β-cryptoxanthine and xanthophyll) than
GORD patients without Barrett’s oesophagus
encouraging the consumption of antioxidant-rich fruits and vegetables,
legumes and whole grain products
◦ Prevent reflux episodes
Zinc supplementation
◦ epidemiological research has found an inverse relationship
between dietary intake of zinc and incidence of oesophageal
adenocarcinoma
◦ animal models have found zinc deficiency to be a significant
contributing factor to the development of Barrett’s
oesophagus
◦ no human research yet but 15-30 mg/day should be adequate
β-carotene supplementation
complete disappearance of Barrett’s oesophagus in 33% of subjects
For GERD how to Improve salivary gland function/esophageal acid clearance?
- Chew food thoroughly
◦ may result in improved salivary gland function over
time and, hence, improved oesophageal acid clearance - Chew gum after meals (30 mins post) and before
bed
◦ increases salivary flow rate, salivary bicarbonate
concentration and rate of swallowing
◦ increases oesophageal pH (i.e., it alkalises the
oesophagus) and helps clear the acid - Potential role for sialagogues as a mouth rinse?
GERD: How to Speed Gastric Emptying?
Avoid foods/drinks that slow gastric emptying
◦ Fatty foods
◦ Alcohol
Probiotics:
- infants: Lactobacillus reuteri Protectis;
- Bifidobacterium lactis HN019
—–Change in whole gut transit time (WGTT)
—–◦ Change in gut S&S
GERD: how to support the nervous system?
If stress plays a role in S&S…
◦ Anxiolytics: lavender, passionflower, kava
◦ Adaptogens: rhodiola, panax ginseng, withania, schisandra
◦ Nervous System trophorestoratives: motherwort, vervain, green milky oats
GERD: diagnostic considerations?
Diagnosis is typically made clinically, based on the
presence of the classic symptoms - a burning feeling
rising from the stomach or lower chest up towards the
neck (heartburn) and/or the effortless return of
stomach contents into the pharynx (regurgitation).
◦ diagnosis is usually confirmed by its good response to therapy
◦ in the conventional medicine, this equates to antacids, proton
pump inhibitors or histamine(2)-receptor antagonists
In natural medicine, this could equate to a short trial
of GI demulcents.
◦ if patients present with the classic symptom picture and
respond to demulcent therapy than that confirms the
diagnosis
GERD: Alarm signs?
Weight loss, dysphagia, epigastric mass upon
examination, anaemia, or signs of internal
bleeding.
◦ patient should be referred for further investigation
(i.e., endoscopy)
If the patient presents with the classic
symptoms of GORD but does not respond to
treatment, then referral is also recommended.
