GERD (Week 3 GI)

Question 1

GER vs GERD

Answer 1

• gastroesophageal reflux (GER) occurs when gastric acid refluxes into the lower esophagus through the lower esophageal sphincter (LES) → not serious, common, heart burn, stress, pregnancy
• gastroesophageal reflux disease (GERD) is when this reflux is chronic and can cause damage to esophagus and lungs

Question 2

GERD symptoms

Answer 2

• Chronic heartburn (not neccessarily always disease)
• Chest pain
• Nocturnal coughing spasms (not always disease - may have just eaten large amount of food before bed)
• Regurgitation
• dysphagia
• unexlpained non-viral ammonia

Question 3

GERD complications

Answer 3

• Esophagitis: inflammation of esophagus →dysphagia
• Scar Tissue → dysphagia
• Stricture: narrowing of esophagus → dysphagia
• Esophageal Cancer (very severe; more likely to get GERD as an effect of cancer not cancer as an effect of GERD) → dysphagia

Question 4

How does esophageal stricture occur?

Answer 4

May be sloughing off cells with bleeding and little pieces of tissue sticking together or narrowing of esophagus. Erosion of lining which can scar and thicken and narrow. Scar tissue can lead to inability to pass food down (dysphagia)

Question 5

Associated factors of GERD

Answer 5

• ↑ Abdominal pressure → LES partially controlled by pressure gradient
• Relaxed LES
• Delayed gastric emptying
• Sensitive esophageal mucosa
• Pyloric obstruction → between stomach and SI
• T2D → vagus nerve dysfunction so delayed gastric empyting

Question 6

pre-disposing conditions for GERD

Answer 6

• obesity
• ascites: excessive fluid in abdominal cavity usually associated with liver disease
• Scleroderma: disease that leads to hardening of tissues
• Pregnancy: increased abdominal pressure, delayed gastric emptying
• Hiatus Hernia: part of stomach passes above diaphragm
• Incompetent LES: congenital
• Renal disease, Crohns disease, food allergies

Question 7

pre-d

GERD treatment

Answer 7

• lifestyle modifications
• nutrition care
• drug therapy
• surgery
• antacids

Question 8

lifestyle modifications for GERD

Answer 8

• upright position for 1 hour after eating
• avoid eating 2-3 hours prior to going to bed
• avoid tight clothing in abdominal area
• stop smoking
• achieve and maintain a healthy weight. Weight loss may be necessary
• Eat smaller meals (↓ fat/ ↑ fiber)
• elevate head of bed 15-20 cm when sleeping

These arent causes of GERD just make it worse

Question 9

Nutrition care for GERD

Answer 9

Foods that may needs to be decreased/eliminated from diet:
* no proof that spicy and acidic foods cause GERD, may just hurt

Question 10

Drug therapy for GERD

Answer 10

Best approach to address condition
* antisecretory drugs (↓ gastric acid production so lower pH) → proton pump inhibitors / histamine H2 receptor antagonists
* motility agents (speed up gastric emptying/ motility) →metoclopramide
* Combination of both addresses acidity and volume

Question 11

Problem with the antisecretory drugs for GERD

Answer 11

• IF production goes down with non-acidic environment and B12 cannot bind
• Acidic stomach also fights off bacteria so as it becomes more neutral some bacteria can thrive and can increase risk for infection - can get into lungs?
• Stomach cells can atrophy in alkaline solution and get disturbance in protein absorption

Concerns especially in elderly

Question 12

surgery for GERD

Answer 12

tightening of LES
* rarely done

Question 13

ana

antacids for GERD

Answer 13

will alleviate symptoms but will not change the disease process because the problem is not too much acid but rather that the acid is in the wrong place