GastroesophagealReflux Disease(GERD)GROUP 6-BSN2C

GastroesophagealReflux Disease

• AKA: “acid reflux disease”

• It is a condition in which the stomach’s acidic contents back up into the esophagus, causing discomfort and, sometimes, tissue damage;

• Any symptoms or esophageal mucosal damage that results from reflux of gastric acid into the esophagus;

Heartburn or acidic indigestion is the most common referred symptom.

Important Reasons to Diagnose and Treat GERD

Negative impact on health-related quality of life

Risk factor for esophageal adenocarcinoma

Conditions or substances associated with reflux:

•Conditions that increases pressure in the stomach

•SUBSTANCES THAT WEAKEN THE LES

•Ascites •Alcohol•Anticholinergic drugs

•Delayed Gastric emptying •Antihistamines•Caffeinated beverages

•Eating Large Meals •Calcium Channel Blockers•Chocolate

•Lying down after eating •Nicotine•Diazepam

•Obesity •Fatty Foods•Spicy foods

•Pregnancy •Progesterone•Theophylline

•Wearing tight clothing around the abdomen

•Trycyclic depressants

What cause GERD?

• LES muscle is weaken or relaxes inappropriately;

• Hiatal hernia, a portion of the stomach protrudes above the diaphragm;

• Obesity: increasing body mass index is associated with more severe GERD;

What cause GERD?

• Zollinger-Ellison syndrome, which can be present with increased gastric acidity due to gastrin production;

• Hypercalcemia, which can increase gastrin production, leading to increased acidity;

• Gallstones, which can impede the flow of bile into the Duodenum, which can affect the ability to neutralize gastric acid

Signs and symptoms

• Heartburn

• Regurgitation

• Dysphagia

• Increased salivation

• Nausea

• Chest pain

Atypical symptoms are associated with GERD

• Chronic cough

• Laryngitis (hoarseness, throat clearing)

• Asthma

• Erosion of dental enamel

• Dentine hypersensitivity

• Sinusitis and damaged teeth

• Pharyngitis

DYSPHAGIA

Interferes with the passage of materials through the esophagus lumen

and into the stomach and is usually caused by an obstruction of the

esophagus, obstruction maybe caused by a “Stricture” or the abnormal narrowing

and this is termed as“ESOPHAGEAL DYSPHAGIA”

HEARTBURN

• is a burning sensation in the chest, just behind the breastbone or in the epigastrium, the upper central abdomen.

• The pain often rises in the chest and may radiate to the neck, throat, or angle of the jaw.

• AKA: pyrosis, cardialgia, or acid

indigestion

NAUSEA & VOMITING

It occurs if there are any obstruction that prevents gastric emptying or patient may be having a underlying stomach motility

disorder.

Treatment Goals for GERD

• Eliminate symptoms

• Heal esophagitis

• Manage or prevent complications

TREATMENT

AVOID EATING AT BEDTIME, MEALS SHOULD BE CONSUME AT LEAST 3 HOURS BEFORE BEDTIME.

SMALL MEALS AND DRINK LIQUIDS BETWEEN MEALS

AVOID BENDING OVER

DON’T WEAR TIGHT FITTING GARMENTS

NO/AVOID NSAIDs

ELEVATE HEAD 6-INCH BLOCKS.

AVOID IRRITATING SUBSTANCES

PHARMOCOLOGICTREATMENTS

Drug of Choice are the following:

Proton-Pump inhibitor;

Histamine 2 receptor blockers

Antacids

Proton Pump Inhibitors

MOA: Suppresses the final step of gastric acid secretion by inhibiting Hydrogen-Potassium ATPase enzyme.

- inhibits up to 90% compared to our Histamine 2 receptor blockers.

SE: headache, abdominal discomfort, dizziness, faltulence, diarrhea

DI: decrease Fe, Folate and B12 absorption

H2 receptor blockers

MOA: blocks H2 receptors of the parietal cells of the stomach, thereby decreasing gastric acid secretion and concentration.

- This may be use to prevent/treat ulcer- Normally, H2 receptors is responsible for

Gastric acid secretion

SE: Headache, confusion , Nausea, Diarrhea, Abdominal pain, anemia, constipation

Antacids

MOA: neutralizes gastric acid concentration and raises the pH of the gastric acid’s concentration

- Use for reflux indigestion and prevention of ulcer

SE: rebound hyperacidity, GI distrubances, systemic alkalosis, electrolyte imbalances

REBOUND HYPERACIDITY

OTHER MANIFESTATIONS/COMPLICATIONS

Gastric acid remains in the esophagus long enough to damage the esophageal lining, the result will be

REFLUX ESOPHAGITIS

Condition in w/c esophageal cells damaged by chronic exposure to stomach acid are replaced by cells that resemble those in the stomach, Carcinogenic. It is termed as

BARRET’S ESOPHAGUS

DYSPEPSIA

This sometimes indicate that the patient is having an underlying serious illnesses

such as GERD and PUD.

INDIGESTION OF FOODS

Erosive Esophagitis

Esophageal CancerEsophageal Cancer

ESOPHAGEAL STRICTURE

DIETARY MANAGEMENT

DECREASE TOTAL FAT INTAKE

LOW CALORIE INTAKE

BLAND DIET

SURGICAL MANAGEMENT

Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux

disease (GERD) and hiatus hernia. In GERD it is usually performed when medical therapy has failed, but with

paraesophageal hiatus hernia, it is the first-line procedure.

CONDITIONS AFFECTING THE STOMACH

GASTRITIS

• Inflammation of the stomach mucosa, may be due to treatments that damages the gastric mucosa (NSAIDs), tissue erosions, ulcers, GI bleeding and these are under ACUTE cases of Gastritis.

• Chronic Gastritis, maybe caused by long-term infections. Helicobacter pylori

• may lead to Pernicious Anemia

PEPTIC ULCER DISEASE

• Open sore that develops the GI mucosa when gastric acid pepsin overwhelm defenses and destroy mucosal tissue.

• Causative agent:

H. pylori degrades the mucus layer of stomach lining and allows the stomach acids

to burn the stomach lining itself

PEPTIC ULCER DISEASE

A classification of Drug which have a topical and systemic effects that can damage

mucosal lining.

NSAIDs