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MSN 6204 GI Final > GERD > Flashcards

GERD Flashcards

1
Q

What are FODMAPs

A

fermentable Oligosaccharides, disaccharides, monosaccharides and polyols

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2
Q

FODMAPs: F = ?

A

Fermentable: not absorbed in upper GIT; feeds the microflora

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3
Q

FODMAPs: O = ?

A

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

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4
Q

FODMAPs: D = ?

A

Disaccharides,
◦ lactose (in malabsorbers)

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5
Q

FODMAPs: M = ?

A

Monosaccharides,
◦ fructose (in malabsorbers)

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6
Q

FODMAPs: AP = ?

A

And Polyols
◦ sorbitol, lactitol, xylitol, and other sugar alcohols

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7
Q

GERD prevalence in Western Nations

A

10-20%

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8
Q

Gerd S and S

A

1.Sensation of heartburn
2.Regurgitation
3.Extraoesophageal manifestations:
◦ Chronic cough
◦ Halitosis
◦ Dental erosions
◦ Chronic laryngitis

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9
Q

What causes GERD?

A

Lower oesophageal sphincter (LOS)
incompetence

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10
Q

Causes of GERD?

A

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

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11
Q

GERD contributing factors?

A
  1. Genetic disposition
  2. Medications: nitrated, CA++ channel blockers, etc.&raquo_space; decrease LES pressure
  3. Smoking
  4. Pregnancy
  5. Psych stress
  6. Higher BMI
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12
Q

GERD dietary contributing factors?

A
  1. Increase acid secretion: alcohol, coffee
  2. Reduce LES pressure: alcohol, chocolate, coffee, fatty meals (incl nuts, seeds
  3. Cause transient LES relaxation: alcohol, peppermint oil
  4. slow gastric emptying: alcohol, fatty foods and meals
  5. impair esophageal motility: alcohol
  6. Agents capable of triggering esophageal pain: tomato/citrus juice, soft drinks, spicy foods, alcohol
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13
Q

OTHER: diet related factors for GERD?

A
  1. 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
  2. chewing food poorly
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14
Q

GERD: Protective Role of Helicobacter pylori?

A

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

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15
Q

Is GERD caused by too little gastric acid?

A

NO. The majority of GORD sufferers in this study had
normal HCL secretion.

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16
Q

Is LHBT a reliable dx tool for SIBO?

A

NO

17
Q

LHBT =

A

lactose hydrogen breath test

18
Q

Conventional treatment for GERD?

A
  1. PPIs = proton pump inhibitors
  2. H2RAs = histamine type 2 receptor antagonists
19
Q

Acute adverse events with PPIs/H2RAs?

A

 diarrhoea
 nausea
 abdominal pain
 headaches

20
Q

Longer-term risks with PPIs/H2RAs?

A

 increased risk of gastroenteritis
 SIBO
 stomach bacterial overgrowth - due to decr HCL
 pneumonia
 spinal fracture
 vitamin and mineral malabsorption - due to decr HCL

21
Q

Natural Medicine Tx Aims for GERD?

A

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

22
Q

GERD: tools to relieve heartburn pain (which is paramount)

A
  1. GI demulcents (marshmallow, slippery Elm, licorice
    - most effective in powdered form mixed with H2O (slurry)
  2. D-limonene: may coat mucosa to protect; may promote healthy peristalsis ( speed gastric emptying)
  3. Melatonin
23
Q

Melatonin mechanisms of action for GERD?

A
  1. inhibits nitric oxide biosynthesis» reducing rate of trnasient LES relaxation
  2. melatonin MT2 receptors&raquo_space; promotes effect of ulcer healling
  3. MT2 receptors&raquo_space; inhibitory action of gastric secretion
24
Q

Options for GERD to Decrease oesophageal inflammation &
promote oesophageal healing?

A
  1. GI demulcents (marshmallow, slippery Elm, licorice
    - most effective in powdered form mixed with H2O (slurry)
  2. Anti-inflammatory phytomedicines for Upper GI: meadowsweet, chamomile, licorice
  3. Vulnerary herbal medicines: traditionally used to help heal the upper gastrointestinal tract include: Althaea officinale, Ulmus fulva,
    & comfrey leaf, aloe vera, calendula flowers
  4. Curcumin
  5. Given that alcohol is a common reflux exacerbating factor,teas/capsules/tablets are probably the preferred method of
    administration.
  6. Melatonin: capable of healing even severe oesophageal ulcerations
  7. 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
25
Q

there is no association b/w GERD and celiac disease: T or F

A

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

26
Q

Should GERD Avoid FODMAP Foods??

A

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

27
Q

low carb diet for GERD?

A

apparently found VLCD effective in reducing
GORD symptoms and reducing distal oesophageal
acid exposure

28
Q

GORD is over-diagnosed in infants: T or F

A

True

29
Q

Lifestyle changes for GERD?

A

Encourage weight loss
Cease smoking
Raise bed-head (20-30 cm)

30
Q

How to prevent esophageal cancer?

A

◦ 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

31
Q

For GERD how to Improve salivary gland function/esophageal acid clearance?

A
  1. Chew food thoroughly
    ◦ may result in improved salivary gland function over
    time and, hence, improved oesophageal acid clearance
  2. 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
  3. Potential role for sialagogues as a mouth rinse?
32
Q

GERD: How to Speed Gastric Emptying?

A

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

33
Q

GERD: how to support the nervous system?

A

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

34
Q

GERD: diagnostic considerations?

A

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

35
Q

GERD: Alarm signs?

A

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.

MSN 6204 GI Final (21 decks)

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