GERD Flashcards

Question

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

Answer 1

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

Answer 2

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

Answer 3

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

Answer 4

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

Answer 5

◦ 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

Answer 6

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?

Answer 7

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

Answer 8

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

Answer 9

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

Answer 10

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.