Unit 3 GERD Flashcards
Gastroesophageal Reflux Disease (GERD)
Definition:
– backward flow of gastric contents thru the lower esophageal sphincter into the esophagus
Gastroesophageal Reflux Disease (GERD)
Physiologic Factors:
-Incompetent lower esophageal sphincter (LES)
-Transient relaxation of lower esophageal sphincter-
Substances that can relax the sphincter such as alcohol, tomato sauce, spicy food, chocolate can prevent LES from restricting properly
-Increase pressure in the stomach r/t overeating, delayed emptying.
(some drugs can delay emptying such as the diabetic drug Acarbose)
Gastroesophageal Reflux Disease (GERD)
Complications: -Erosive esophagitis
Can occur r/t exposure to the acid; the pt gets ulcerations then the tissue tears, bleeds and then scarring occurs; once scarred the function is decreases
~leads to difficulty swallowing,
~painful swallowing,
~horrible pain caused by stricture
Gastroesophageal Reflux Disease (GERD)
Complications: Barrett’s esophagus
– step before cancer; the epithelium changes and becomes more resistant to the acid
Gastroesophageal Reflux Disease (GERD)
Complications: -Esophageal stricture
Lumen becomes narrow. Pt C/O food stuck in throat
TX with dilation of esophagus
Problems:
~Dysphagia
~malnutritionGastroesophageal Reflux Disease (GERD)
Factors Contributing to Reflux
-Increase gastric volume
Position pushing gastric contents upwards (e.g., lying down, bending)
-Increase gastric pressure r/t tight clothing, obesity, pregnancy
-Hiatal hernia – medical condition that aggravates reflux
Gastroesophageal Reflux Disease (GERD)
Manifestations
- Heartburn (dyspepsia) – especially after a HIGH FAT meal, bending over, reclining
- Regurgitation
- Dysphagia
- Atypical chest pain – doesn’t follow MI symptoms
- Sore throat – r/t pharynx damage, difficulty speaking
- Hoarseness- r/t damage, may develop chronic cough r/t to the irritation
- Water brash – hypersalivation
- Odynophagia – painful swallowing
Gastroesophageal Reflux Disease (GERD)
Incidence
- Affects 15-20% of adults (more than 50 million)
- More common in people over 45 years old
- 10% of people experience daily symptoms; interferes with life
Gastroesophageal Reflux Disease (GERD)
Diagnostic Tests
-Barium Swallow – X-ray records flow of barium thru esophagus
-EGD (esophagogastroduodenoscopy)
pt sedation
scope thru mouth, down esophagus, into stomach
-24° ambulatory pH monitoring
A catheter with a monitor attached is placed down the pt’s nose and into esophagus where the acid levels/pH are measured for 24°
After 24° the catheter/monitor is removed
Helps determine frequency and duration of episodes of reflux.
~Very uncomfortaple procedure
~Non compliance D/T nasal Catheter
-Bravo Capsule
attaches a capsule in the esophagus
sends messages to a monitor that the pt wears
falls off in 48° and is expelled with feces
Gastroesophageal Reflux Disease (GERD)
Medications: Antacids –
neutralize stomach acid
produce symptom relief; relieve pain that people refer to as heartburn
available in liquid suspension – shake well
available in chewable tablets – drink full glass of water
Magnesium compounds
Aluminum compounds
Calcium compounds
Sodium bicarbonate
Gastroesophageal Reflux Disease (GERD)
Medications: Antacids – Magnesium compounds
Milk of Magnesia
Riopan
A.E: Hypermagnesium
Gastroesophageal Reflux Disease (GERD)
Medications: Antacids – Aluminum compounds
Maalox
Mylanta
Amphogel
Rolaids
Gastroesophageal Reflux Disease (GERD)
Medications: Antacids – Calcium compounds
Tums
A.E: Hypercalcemia
Gastroesophageal Reflux Disease (GERD)
Medications: Antacids – Sodium bicarbonate
Baking soda
Alka Seltzer
Gastroesophageal Reflux Disease (GERD)
Medications: H2 Receptor Blockers “tidine”
-Histamine Blocker-
-These DO NOT neutralize the acid, they REDUCE acids by BLOCKING H2 histamine
H2 receptor blockers block the ability of histamine to stimulate acid secretions (hydrochloric acid),
- H2 receptor blocker stops the stimulation before it can start
-Less stimulation = less HCl acid = less GERD, reflux
H2 receptor blockers include:
- Cimetidine (Tagamet)
- Ranitidine (Zantac)
- Famotidine (Pepcid)
- Nizatidine (Axid)
Gastroesophageal Reflux Disease (GERD)
Medications: H2 Receptor Blockers “tidine”
Cimetidine (Tagamet)
oral or IV not used often r/t drug interactions cause Dilantin and Coumadin levels to rise absorption of the drug is slowed down if taken with food Adverse affects: -decrease libido -Impotence -Confusion -Hallucinations
Gastroesophageal Reflux Disease (GERD)
Medications: H2 Receptor Blockers “tidine”
Ranitidine (Zantac)
Oral, IM and IV, also OTC
more potent than Tagamet, but far fewer drug interactions and side effects
Gastroesophageal Reflux Disease (GERD)
Medications: H2 Receptor Blockers “tidine”
Famotidine (Pepcid)
Oral, IV push or drip
Gastroesophageal Reflux Disease (GERD)
Medications: H2 Receptor Blockers “tidine”
Nizatidine (Axid)
Oral capsules
Gastroesophageal Reflux Disease (GERD)
Medications: Proton Pump Inhibitors (PPIs)”prazole”
(Most effective)
-Most effective for suppressing gastric acid secretion
Used interchangeably (can substitute one PPI for another)
-Cost effective
-Block final pathway of acid production
-Affects last long after drug is cleared from the body
-Rare side effects
-Take on empty stomach
Types:
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeprazole (AcipHex)
Pantoprazole (Protonix)
Esomeprazole (Nexium)
Gastroesophageal Reflux Disease (GERD)
Medications: Proton Pump Inhibitors (PPIs)”prazole”
Types:
Omeprazole (Prilosec)
Oral
Lansoprazole (Prevacid)
Oral and IV
Rabeprazole (AcipHex)
Oral
Can increases Digoxin level by 20% = digitoxicity
Pantoprazole (Protonix)
Oral or IV
Use a filter with IV r/t precipitates that can leak out
Esomeprazole (Nexium)
Phlebitis complication
Not compatible with anything other than NS, LR, or D5W
Studies being done: drip vs IV push
Zegrid-
New drug. Combo Prilosec and Sodium Bicarbonate
Gastroesophageal Reflux Disease (GERD): Procedures
Nissen Fundoplication “stomach wrap”
-Laparoscopic or open surgery
-no incision is made; the stomach is wrapped around the lower esophagus and sutured together
-pt can no longer belch or vomit
-pt can no longer drink soda pop r/t lack of ability to belch
-good surg. for PT suffering with daily GERD
ALSO:
-The Transoral Incisionless Fundoplication (TIF) is a surgical procedure performed through the mouth and without incisions
Gastroesophageal Reflux Disease (GERD): Procedures
Nissen Fundoplication “stomach wrap” Post-op Care
- NG tube, NPO, Important NOT MANIPULATE NG tube
- Keep NG patent to prevent build up of pressure and nausea
- Nausea = retching = ripping of sutures
- Important- C&DB – will be painful for pt; splint with pillows Shallow breathing r/t pain
Gastroesophageal Reflux Disease (GERD): Procedures
Nissen Fundoplication “stomach wrap” :Post-Hospital Care
Avoid food and fluid at bedtime which can put pressure on LES
Frequent small feedings (so as not to stretch sutured area)
Avoid gas in stomach (gas bloat syndrome)
-Carbonated beverages
-Gum chewing
-Drinking with a straw
-Gas-producing foods
-Avoid lifting and straining r/t increase in pressure on LES
Gastroesophageal Reflux Disease (GERD)
Medications: Prokinetic drugs- Metoclopramide (Reglan)
-Enhances esophageal clearance and gastric emptying
-Causes tightening of LES
-Increase mobility of GI; stomach especially
-Speeds food thru
Prokinetic drug:
Metoclopramide (Reglan)
Oral and IV
Gastroesophageal Reflux Disease (GERD): Procedures Stretta Procedure
- Causes a stricture at the LES by radio frequency energy
- Done thru endoscopy
- Puts tiny holes in esophageal lining, as those heal they tighten and contract the LES
Gastroesophageal Reflux Disease (GERD): Procedures
LINX System
a band of magnets that tighten around the sphincter
Gastroesophageal Reflux Disease (GERD):
Lifestyle Modifications for GERD
-Eat smaller meals – 4-6 small feedings; pressure on LES
-Avoid foods that aggravate symptoms:
~Alcohol
~Chocolate
~citrus fruits
~fatty foods
~mints
~coffee
~caffeine
~Avoid lying down within 3 hours of eating
-Elevate HOB (Head Of Bed); by 8-10”
-Smoking Cessation dramatically reduces LES pressure
-Lose weight – helps reduce pressure
-Avoid bending
-Avoid tight clothing
