Gastroesophageal Reflux Disease and Exercise

DONE BY: EMAN AL-ZAWWADFN 530

Content

What is GERD Pathophysiology of GERD Causes Clinical manifestation Diagnostic tests Complications Treatment Literature review

Definition of Gastroesophageal reflux disease (GERD)

It is a digestive disorder which caused by flowing of gastric acid from the stomach into the esophagus.

Causes

1- Dietary factor

Cont.

Lifestyle factor Being overweight and obese.Position and activity such as bending and straining.

Medication such as nonsteroidal anti-inflammatory (NSAIDs) drugs (aspirin and ibuprofen ) Beta blockers Estrogen

People who are at risk

Pregnant women because during pregnancy, as the uterus grows, it pushes on the stomach and then forces stomach acid up into the esophagus.

Hiatal hernia.

Pathophysiology

Typically When The lower esophageal sphincter (LES) muscle relaxes too often or for too long, the acid from the stomach refluxes back into the esophagus, causing heartburn.

LES relaxation, decreased gastric emptying, high secretion of acid in the stomach, impaired mobility of the esophageal and increase the pressure in the abdomen

Gastric and intestinal enzymes (pepsin, trypsin, bile salts) also reflux up into the

esophagus The flow back of the gastric acid secretion into the esophagus

Irritation and erosion in the mucosal lining of the the esophagus

Esophagitis

GERD

Hiatal hernia

LES relaxation

Esophageal sphincter above diaphragm

The flow back of the gastric acid

secretion into the esophagus

Because diaphragm is reduced, pressure

develops on the LES

Part of stomach lies with esophagus

GERD

Clinical manifestation

Heartburn Vomiting of food or sour liquid. Discomfort when swallowing Hoarseness Sore throat Asthma Chest pain

Complications

Uncontrolled or untreated GERD can cause serious health issues. Ulcers.

Barrett’s esophagus esophageal cancer.

Diagnostic tests

Barium swallowIt examines the organs of the upper part of the digestive system to look for a hiatal hernia or other problems that may be contributing to reflux symptoms. upper EndoscopyIt examines the lining of the esophagus for signs of GERD-related injury. This endoscope allows  doctors to see the inside of upper digestive system and also to insert instruments for biopsy purposes.

Diagnostic tests

Bernstein test.It helps to confirm the symptoms of GERD. It is performed by dripping a mild acid through a tube placed in the esophagus. Esophageal manometry. It helps to determine the strength of the muscles in the esophagus.

Diagnostic tests

pH monitoring. It measures the acidity inside the esophagus and evaluate (GERD). This test is performed by a thin, plastic tube is placed into a nostril, guided down the throat, and then into the esophagus just above the lower esophageal sphincter. There is a sensor at the end of the tube inside the esophagus to measure pH, or acidity. Also, there is a monitor at The other end of the tube outside the body to records the pH levels for a 24 to 48 hours .

Treatment

Nutritional Therapy and Lifestyle Modification Watch the food intake and limit fried and fatty foods…etc. Eat smaller portions. Avoid overeating. Loss weight Decrease consumption of alcohol. Do not lie down or go to bed right after a meal. Instead, wait a couple of

hours. Elevate the head when you lie down by placing another pillow Use medication such as Antacid , H2 receptors antagonist. Exercise?

Literature review

Title of the study: The relationship between gastroesophageal reflux disease and the level of physical activity.

Authors: Jóźków P1, Waśko-Czopnik D, Dunajska K, Medraś M, Paradowski L.

Date published: 2007 Aug 25 Purpose : to examine the association between the level of everyday

physical activity and parameters of the disease (pH-metry, symptoms) in patients diagnosed with GERD.

Method

1- By using the international physical activity questionnaire (7-day recall), they assessed the level of physical activity of 100 GERD patients and identified them as groups. Group 1 =low level physical activity. Group 2 = moderate physical activity. Group 3 = high physical activity. The amount of physical activity was expressed as multiples of resting

metabolic rate and minutes of performance during a week (METs-minute/week).

To find the relationships between everyday physical activity and pH-metric indices of GERD, they used a multivariate regression for analysis.

The covariates in the study were (age, BMI, smoking and gender).

Cont.

2- PH monitoring for studied subjects It was performed by using a dual electrode catheter with

antimony electrodes with standard 10 cm spacing between Them.

there were two spots for monitoring the distal and proximal pH. The distal electrode was placed 5 cm above the proximal Border

of LES and the proximal electrode was placed 15 cm above LES.The pH probe and the pH recorder were retained For a 24 hour period.

Inclusion criteria : all GERD patient who had undergone 24-h pH monitoring in a

clinical setting. Patients who experience symptoms daily. Exclusion criteria: Patients who use medication for GERD and can effect the

symptoms and PH measurements. Patients with restricted locomotor abilities.

Results

There were weak association between the amount of everyday physical activity and pH-metric parameters of GERD when was evaluated 5 cm and 15 cm above the lower esophageal sphincter (LES).

This is because the number of the self-reported GERD symptoms was 6 symptoms in groups 1, 2 and 7 symptoms in group 3. therefore, There was no significant difference among the three group of physical activity.

Results

However, they only found significant correlations between pH-metric parameters and covariates.

between the number of reflux episodes 15 cm above LES and gender (beta -0.25; p <0.05)

between the number of reflux episodes 5 cm above LES and age (beta -0.24; p <0.05).

Conclusion/discussion

There is no association between the level of daily physical activity and the symptoms of GERD.

Although there was no notable difference in the numbers of symptoms between the three levels of physical activity, more studies are needed.

Strength/ limitation of the study

Strength:Large sample size

Limitation:Age and gender were unknown for those patients who obtained significant correlation with number of reflux episodes.

Relevance to the field(s) of nutrition and exercise science

Nutritional therapy play an important roles in treating patients with GERD. by Watching food intake and limiting fried and fatty foods GERD can be prevented as well.

Maintaining healthy weight can help. Exercise is good for health but it may not by helpful with GERD

especially the heavy one.

Reference Józków, P., Wasko-Czopnik, D., Dunajska, K., Medras, M., &

Paradowski, L. (2007). The relationship between gastroesophageal reflux disease and the level of physical activity. Swiss Medical Weekly, 137(33-34), 465-471. retrieved from http://www.smw.ch/docs/pdf200x/2007/33/smw-11887.pdf

Granderath, F., & Pointner, R. (2006). Chapter 2: The Pathophysiology Of Gerd. In Gastroesophageal reflux disease: Principles of disease, diagnosis, and treatment (pp. 13-22). Stefan: Springer New York.