Gastroesophageal Reflux Disease GERD Ernesto Garcia Angela Gomez

Gastroesophageal Reflux Disease (GERD) Ernesto Garcia Angela Gomez Sandra Hernandez Valerie 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 Normal Esophagus →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 mm. Hg Inspiration: Increases 30 mm. Hg Expiration: Decreases 30 mm. Hg 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. • p. H Monitoring: 24 -hour intraluminal monitoring

Other Common Procedures • Barium Radiology studies • Gastric Analysis • Bernstein Test • Urea Breath Test

Lab Values • p. H monitoring: • < p. H 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 40 mg one daily EER: 2000 -2100 kcal (based on Mifflin-St. Jeor) EPR: 87 g of protein (based on 0. 8 g/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. 1. Obesity (Class I) related to high caloric intake BMI: 37. 6 and 24 hour food recall. 1. 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. Chicken b. Caffeine c. Yogurt d. Kale

Question Two 2. What test is performed in order for a patient to be diagnosed with GERD? a. Barium X-Ray b. Laboratory test c. Endoscopy d. 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 stomach b. Relaxing of the lower esophageal sphincter c. Weak diaphragm d. Changes in esophageal squamous cells

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