Gastroesophageal Reflux Disease

(GERD)

Ernesto GarciaAngela Gomez

Sandra HernandezValerie Obarski

What is GERD?Definition:Gastroesophageal reflux disease (GERD) is defined as a condition with symptoms or complications resulting from the reflux of gastric contents into the esophagus or beyond, into the oral cavity (including the larynx) or lung.

Epidemiology

• 10-20% U.S. population• Higher prevalence from 50-70 years of age

Symptoms

Common:• Dysphagia• Heartburn• Increased salivation• Belching• Bad breath• Chest pain

Complications of untreated GERD symptoms:• Impaired swallowing• Aspirations of gastric content into the

lungs• Ulceration• Barrett’s esophagus

Pathophysiology

NormalEsophagus →LES→ Stomach

GERD Esophagus→ LES → Stomach→Esophagus

GERD can developed as a consequence of the diet and behavior.

Hiatal Hernia• 94% of patients’ esophagitis reflux

related to hiatal hernia• Higher reflux severity• Large contributor to Barrett’s

esophagus

Change in pressure • Resting: Changes 5-10 mmHg• Inspiration: Increases 30 mmHg• Expiration: Decreases 30 mmHg • Body position • Others: Progesterone, CCK,

Bombesin

Transient LES relaxations

Diet and Behavior that worsen symptoms and contribute to high gastric acidity● Diet ○ High in fat○ Caffeine containing○ Alcohol○ Chocolate○ Peppermint

● Behavior○ Smoking○ Obesity

Diagnosis

• Diagnoses through typical signs and symptoms

• Endoscopic procedure: Gastrointestinal endoscopy with biopsy

• Esophageal Manometry: Evaluation of the lower esophageal sphincter.

• pH Monitoring: 24-hour intraluminal monitoring

Other Common Procedures

• Barium Radiology studies

• Gastric Analysis

• Bernstein Test

• Urea Breath Test

Lab Values

• pH monitoring:

• < pH 4 = GERD

• Duration of longest reflux episode.

Medical Treatment

3 goals in treating GERD● Increase LES competence○ Factors: cigarette smoking, medication use, obesity

● Decrease gastric acidity○ Medication, avoid trigger foods,

consume smaller meals● Improve passage of contents from the esophagus

to the stomach○ Remain upright, lose weight, loose clothing,

raise the head of the bed while sleeping

Commonly prescribed drugs

Antacids• Neutralize acidity and

reduce heartburn • Tums, Mylanta, Alka-

Seltzer, Rolaids, Pepto-Bismol

Histamine blocking agents• Lower acid content in

stomach• Pepcid AC, Zantac 75,

Tagamet HB

Proton pump inhibitors• Reduce acid production• Prilosec, Protonix, Nexium

Prokinetic agents • Strengthen LES• Urecholine, Reglan

Foaming agents• Antacid and barrier • Reduce symptoms• Gaviscon, Foamicon

Surgical Treatment• Nissen fundoplication• Most common• Laparoscopically• Wraps the fundus of the

stomach around lower esophagus

• Partial fundoplication • Roux-en-Y gastric bypass• LINX

Complications of GERD - Barrett’s Esophagus• Caused from a change of esophageal

squamous cells to columnar cells

• From malignant to adenocarcinoma

• Patients who are unresponsive to GERD treatments are more likely to develop Barrett’s Esophagus

• Most patients are diagnosed while have an endoscopy for GERD treatment

• Treatment remain the same untill, cancer develops

Case Study Homer Simpson is a 38 y.o. Male who complains of frequent belching, regurgitation and heartburn. He considers himself a

heavy drinker and spends most his nights at Moe’s Tavern drinking Duff Beef averaging 12 beers a day. His favorite food

include donuts, pork chops, hamburger, hoagies, hot dogs and just about everything else. He overindulges when he eats and

has almost put the The Frying Dutchman an All you Eat restaurant out of business when he continuously ate for hours after

the restaurant had closed. 24 hour recall: breakfast consist of donuts, lunch include Krusty Burgers, fries and Squishees,

dinner consist of ½ whole pig, bowl of mashed potatoes, 1 bowl of moosh, 2 pieces of floor pie. Homer snacks during the day

on Chippos chips, Nuts & Gum, Powersauce Bar, 1 hotdog and 64 slices of cheese. Dr. Hibbert, Homer’s primary care

physician, has diagnosed him with GERD and placed him on Nexium.

Ht: 6’0”; Wt: 239 lbs

BMI: 32.5 [Obesity class I]; IBW: 178 lbs; IBW %: 134%; ABW: 193 lbs

Test: Barium X-Ray revealed relaxing of the lower esophageal sphincter

Medication: Nexium 40mg one dailyEER: 2000-2100 kcal (based on Mifflin-St. Jeor)EPR: 87g of protein (based on 0.8g/kg)

PES Statements

1. Altered GI function related to relaxation of lower esophageal sphincter as

evidence by barium x-ray results and patient complaining of heartburn.

2. Obesity (Class I) related to high caloric intake BMI: 37.6 and 24 hour food

recall.

3. Excess alcohol intake related to overindulgence when drinking as evidence by patient stating he drinks 12 beer a day.

Question One

1.Which foods do most GERD patients need to avoid?a.Chickenb.Caffeinec.Yogurtd.Kale

Question Two

2. What test is performed in order for a patient to be diagnosed with GERD?

a.Barium X-Rayb.Laboratory testc.Endoscopyd.None; diagnosis can be made based on

patients signs and symptoms

Question Three

3. In Hiatal Hernia, which is the most common cause of esophageal reflux?

a.Changes in pressure in the stomachb.Relaxing of the lower esophageal

sphincterc.Weak diaphragmd.Changes in esophageal squamous cells

ReferencesGERD. (n.d.). Retrieved February 15, 2015, from http://www.mayoclinic.org/diseases-conditions/gerd/basics/treatment/con-20025201

Banki , M.D., F. (n.d.). Larparscopic Nissen. Retrieved February 15, 2015, from http://www.memorialhermann.org/digestive/laparoscopic-nissen-fundoplication/

Daller, J. (2014, July 30). Diagnostic laparoscopy: MedlinePlus Medical Encyclopedia. Retrieved February 15, 2015, from http://www.nlm.nih.gov/medlineplus/ency/article/003918.htm

Dugdale, D. (2012, November 12). Taking antacids: MedlinePlus Medical Encyclopedia. Retrieved February 17, 2015, from http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000198.htm

Gorecki, P. (2001, January 1). Gastro-esophageal reflux disease (GERD). Retrieved February 15, 2015, from http://www.ncbi.nlm.nih.gov/books/NBK6896/?report=classic#A323

Nelms, M., & Sucher, K. (2016). Nutrition therapy and pathophysiology (Third ed.). Cengage Learning.

Castell, D. , Murray, J. , Tutuian, R. , Orlando, R. , & Arnold, R. (2004). Review article: The pathophysiology of gastro-oesophageal reflux disease - oesophageal manifestations. Alimentary Pharmacology & Therapeutics, 20 Suppl 9(s9), 14-25.

Boeckxstaens, G. (2007). Review article: The pathophysiology of gastro-oesophageal reflux disease. Alimentary Pharmacology & Therapies, 26(2), 149.