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Flashcards in GERD Deck (37)
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1

GERD

Common problem
Chronic manifestation of mucosal damage
Caused by reflux of gastric contents into lower esophagus
Not a disease, but a syndrome

2

Etiology and Patho

No one single cause
Results when:
-Defenses of lower esophagus are overwhelmed by reflux of gastric contents into esophagus
Reflux of HCl acid and pepsin secretions cause irritation and inflammation
Intestinal proteolytic enzymes and bile salts add to irritation

3

Predisposing factors

Hiatal hernia
Incompetent lower esophageal sphincter (LES)
-Antireflux barrier
Decreased esophageal clearance
Decreased gastric emptying

4

Incompetent LES

Primary factor in GERD
Results in decreased pressure in distal portion of esophagus
-Gastric contents move from stomach to esophagus
-can be due to certain drugs and foods

5

Risk factors

Obesity
Pregnant women
Cigarette and cigar smoking
Hiatal hernia

6

Heartburn (pyrosis)

Most common clinical manifestation
Burning, tight sensation felt beneath the lower sternum and spreading upward to throat or jaw
Felt intermittently

7

Dyspepsia

Pain or discomfort centered in upper abdomen

8

Regurgitation

Described as hot, bitter, or sour liquid coming into throat or mouth
Hypersalivation may also be reported

9

Most individuals have mild symptoms like

Heartburn after a meal
Occurs once a week
No evidence of mucosal damage

10

Healthcare provider should evalauate

Heartburn occurring more than once a week, rated as severe, or occurring at night and waking patient
Older adults w/ recent onset of heartburn

11

Heartburn occurs

Following ingestion of food or drugs that decrease LES pressure
Directly irritates esophageal mucosa

12

Potential respiratory symptoms

Wheezing
Coughing
Dyspnea
Nocturnal coughing w/ loss of sleep

13

Otolaryngologic symptoms include

Hoarseness
Sore throat
Lump in threat
Choking

14

Chest pain

Described as burning, squeezing, or radiating to back, neck, jaw, or arms
Can mimic angina
More common in older adults
Relieved w/ antacids

15

Esophagitis

*
*Related to direct local effects of gastric acid on esophageal mucosa
Inflammation of esophagus
Frequent complication
Repeated exposure: esophageal stricture (resulting in dysphagia)

16

Barrett's esophagus (esophageal metaplasia)

Replacement of normal squamous epithelium w/ columnar epithelium
Precancerous lesion
Thought to be primarily due GERD
Diagnosed in 5%-15% of patients w/ chronic reflux
S/Sx: none to perforation
Must be monitored every 2-3 years by endoscopy

17

Respiratory Complications

Due to irritation of upper airway by secretions
-Cough
-Bronchospasm
-Laryngospasm
-Cricopharyngeal spasm
Potential for asthma, bronchitis, and pneumonia

18

Dental erosion complications

From acid reflux into mouth
Especially posterior teeth

19

Diagnostic studies

History and physical exam
Barium swallow (can detect protrusion of gastric fundus)
Upper GI endoscopy (useful in assessing LES competence, degree of inflammation, scarring, strictures)
Biopsy and cytologic specimens (differentiate cancer from Barrett's esophagus)
Esophageal manometric (motility) studies (measure pressure in esophagus and LES)

20

Radionuclide Tests (diagnostic study)

Detect reflux of gastric contents
Demonstrate rate of esophageal clearance

21

Monitoring pH

Laboratory or 24-hr ambulatory
Determine esophageal pH by using specially designed probes
4-5 region in stomach. Should be more basic than acidic

22

Lifestyle modifications

Avoid triggers

23

Nutritional therapy

Decrease high-fat foods
Take fluids between rather than with meals
Avoid milk products at night
Avoid late-night snacking or meals
Avoid chocolate, peppermint, caffeine, tomato products, orange juice
Weight reduction therapy
Chewing gum and oral lozenges can increase saliva production and help patients w/ mild symptoms

24

Proton Pump Inhibitors (PPI)

Drug therapy
Promotes esophageal healing in 80%-90% f patients
Decrease incidence of esophageal strictures
Headache is most common side effect
Omeprazole
Long-term use or high doses of PPIs may increase the risk of fractures of hip, wrist, and spine
Associated w/ increased risk of C. difficile infection in hospitalized patients

25

Histamine-2 receptor (H2R) blockers

Drug therapy
Decrease secretion of HCl acid
Reduce symptoms and promote esophageal healing in 50% of patients
Cimetidine
Side effects are uncommon

26

Acid protective

Drug therapy
Used for cytoprotective properties
Sucralfate

27

Cholinergic

Drug therapy
Increase LES pressure
Improve esophageal emptying
Increase gastric emptying
Bethanechol

28

Prokinetic drugs

Drug therapy
Promote gastric emptying
Reduce risk of gastric acid reflux
Meoclopramide

29

Antacids

Drug therapy
Quick but short-lived relief
Neutralize HCl acid
Taken 1-3 hrs after meals/at bedtime
Maalox, Mylanta

30

Surgical therapies when necessary

Failure of conservative therapy
Medication intolerance
Barrett's metaplasia
Esophageal stricture and stenosis
Chronic esophagitis
*Nissen and Toupet fundoplications