Gastroesophageal Reflux GER GER considered as a normal
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Gastroesophageal Reflux (GER) GER considered as a normal physiologic process that occurs several times a day in healthy infants, children and adults. Lower esophageal sphincter (LES) permits gastric contents to enter the esophagus.
Gastroesophageal Reflux Disease (GERD) • Serious, chronic or long-lasting form of GER. • Defined as symptoms or complications resulting from the reflux of gastric contents into the esophagus and even into the oral cavity (including larynx) or lung. • Symptoms include heart burn that is painful, burning sensation, regurgitation or both. • Symptoms may be experienced in the evening known as nocturnal GERD, which has a greater impact on quality of life compared to daytime GERD.
GERD • Nocturnal GERD is associated with severe esophagitis (inflammation of the esophagus). • It can lead to sleep disturbances. • Definite relationship between GERD and obesity (BMI, waist circumference, weight gain). • GERD is frequent during pregnancy in the form of heart burn and may begin in any trimester.
GERD • Chest pain may be a symptom of GERD. • Presence of GERD indicates an underlying motility disorder such as stricture or malignancy. • Changes in lifestyle, including diet. • Caffeine, alcohol, tobacco and stress. • Recommended small but frequent eating. • Alcoholic and carbonated beverages which enhance gastric distension should be avoided. • Highly acidic foods such as citrus juices and tomatoes should be avoided because they cause pain when the esophagus is already inflamed.
GERD • Foods seasoned with chili powder and pepper can cause discomfort. • Well balanced healthy diet is preferable. • Use of tobacco products is contraindicated with reflux. Smoking should be stopped.
Nutrition Management of GERD • Goal: Decrease exposure of esophagus to gastric contents. • Avoid: Large meals, dietary fat and alcohol. • Goal: Decrease acidity of gastric secretions. • Avoid: Coffee and fermented alcoholic beverages. • Goal: Prevent pain and irritation. • Avoid: any food that the patient feels exacerbartes his symptoms.
Gastrectomy • Total Gastrectomy means removal of entire stomach. • It is performed for malignancies that affect the middle or upper stomach. Colostomy: It is a surgically created opening from the colon to the skin when a portion of the large intestine is removed or bypassed. It can originate from any part of the ascending, transverse, descending, or sigmoid. It typically starts functioning 2 -5 days after surgery.
Ileostomy • An ileostomy is a surgically created opening from the distal small bowel (most often the terminal ileum) to the skin when the entire colon, rectum, and anus are removed or bypassed. • Start functioning within 24 hours after surgery.
