Upper GI: Gastroesophageal Reflux Disease (GERD)

Upper GI:GERDGroup 5:Brooke Bevins, Lindsey Gamrat, Briana McKenney, Emily Mendel, Latifah Gray, Hannah Crist

Patient HistoryJoe is a 47 YO male who came in c/o intense burning sensation in his chest accompanied by nausea. He reports that he has also been belching frequently which gives him the sensation of regurgitation in his throat.Joe smokes a pack of cigarettes per day and consumes moderate amounts of alcoholDx with asthma at 14 YORecently dx with hiatal herniaNKA to foodReports that he frequently get a burning sensation in chest after dinnerLate dinner then watches TV in chair and goes to bedSymptoms worsen when he lays downTakes antacids occasionally which helpsPhysical and DiagnosticsNurse calculates BMI as 31.2A BMI over 30 indicates a patient is obeseA stool occult blood test is positiveIndicative of bleeding somewhere in the GI tractNever had an endoscopy or acid probe testPrevalenceOccurs in both men and womenMost common in those that are overweight

Risk FactorsObesityHiatal herniaPregnancySmokingDry mouthAsthmaDiabetesDelayed stomach emptying

PathophysiologyGERD- Gastroesophageal reflux disease (aka acid-reflux disease) is caused by excessive reflux occurring, either in frequency or volume, or if the esophagus fails to contract in response to stomach contentsCommon cause is a hiatal herniaEffective diets relax the lower esophageal sphincter and dont stimulate gastric secretions

http://www.youtube.com/watch?v=TdK0jRFpWPQSymptoms and RisksHeart burn with pain occurring behind the sternumPain can sometimes radiate to the neck and the back of the throatThose at risk include pregnant women and obese peopleIn women, BMI may be associated with the symptoms of GERD for those who are normal or overweight.Moderate weight gain may aggravate the symptomsSmoking increases the risk of GERD

DiagnosisX-ray of esophagusChalky liquid that coats the GI tract and allows physician to see inside of tract and determine damage that has been done.EndoscopyPhysician passes a flexible tube with a light and camera down the esophagus to view the stomach and esophagus

Dietary InterventionsLoose weight if it is neededAvoid lying down for three hours after eatingEat frequent and smaller portioned mealsDo not eat close to bed timeStay away from food that may worsen GERD symptoms:Citrus fruits, chocolate, caffeine, alcohol, fatty/fried foods, garlic, onions, spicy foods, tomato-based foodsNursing InterventionsEducate client and family on importance of a healthy diet.Educate client about risks attached to smoking and how it perpetuates his condition.Promote regular exercise.Educate client foods that are harmful to his condition.*see dietary interventionsAssist in obtaining resources to help track nutrient/calorie intakeChooseMyPlate.gov/SuperTrackerhttps://www.choosemyplate.gov/SuperTracker/default.aspx

MedicationsOTC: Antacids/any medicine that slows acid production and heals the esophagusAlka-SeltzerPrescription Strength: H-2 receptor Blockers (Pepcid, Zantac)Proton Pump Inhibitors (Prevacid, Prilosec)Surgery is a last resort treatment that occurs if the medications do not help in controlling GERDAlternative MedicationsNot proven to treat or reverse damage, but are proven to provide some reliefAcupunctureRelaxation TherapyGuided ImageryProgressive Muscle RelaxationHerbal remedies *Licorice, Slippery Elm, Chamomile,Marshmallow

*May interfere with some medicationsPatient GoalsMaintains a healthy weightExcess weight creates pressure on abdomen and acid will build up in the esophagus.Patient avoids food and drinks causing heartburnFried foods, fast foods, soda, tomato sauce, onion, garlic, spicy foods, etc.Eats smaller mealsObese clients should work towards loosing weight and maintaining a healthier food diet.Doesnt lie down after eatingWait at least three hours to lie down.

OutcomesWeight loss for obese clientsHealthier food dietEngage in weekly physical activitiesSmaller meal portionsStop/reduce smoking habits

Long-Term ImplicationsNarrowing of the esophagus (esophageal stricture)An open sore in the esophagus (esophageal ulcer)Precancerous changes to the esophagus (Barretts esophagus)Questions?

ReferencesFennerty, Brian. (2007, May). Heartburn, gastroesophageal reflux (ger), and gastroesophageal reflux disease (gerd). Retrieved from http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/Longstreth, G. F. (2011, August 11).Gastroesophageal reflux disease. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/Center for Disease Control and Prevention. (2011, September 13).About bmi for adults. Retrieved from http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.htmlMayo Foundation for Medical Education and Research (MFMER). (1998-2012). Retrieved from http://www.mayoclinic.com/health/gerd/DS00967/DSECTION=lifestyle-and-home-remedies

ReferencesLutz, Carroll & Przytulski, Karen. (2011). Nutrition and Diet Therapy. Philadelphia, PA: F.A. Davis Company Mayo Clinic Foundation for Medical Education and Research. (2011). GERD. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/gerd/DS00967