Upper GI: GERD

1. Upper GI:GERD Group 5: Brooke Bevins, Lindsey Gamrat, Briana McKenney, Emily Mendel, Latifah Gray, Hannah Crist

2. Patient History • Joe 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 ½ a pack of cigarettes per day and consumes moderate amounts of alcohol • Dx with asthma at 14 YO • Recently dx with hiatal hernia • NKA to food • Reports that he frequently get a burning sensation in chest after dinner • Late dinner then watches TV in chair and goes to bed • Symptoms worsen when he lays down • Takes antacids occasionally which helps

3. Physical and Diagnostics • Nurse calculates BMI as 31.2 • A BMI over 30 indicates a patient is obese • A stool occult blood test is positive • Indicative of bleeding somewhere in the GI tract • Never had an endoscopy or acid probe test

4. Prevalence • Occurs in both men and women • Most common in those that are overweight

5. Risk Factors • Obesity • Hiatal hernia • Pregnancy • Smoking • Dry mouth • Asthma • Diabetes • Delayed stomach emptying

6. Pathophysiology • GERD- 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 contents • Common cause is a hiatal hernia • Effective diets relax the lower esophageal sphincter and don’t stimulate gastric secretions http://www.youtube.com/watch?v=TdK0jRFpWPQ

7. Symptoms and Risks • Heart burn with pain occurring behind the sternum • Pain can sometimes radiate to the neck and the back of the throat • Those at risk include pregnant women and obese people • In women, BMI may be associated with the symptoms of GERD for those who are normal or overweight. • Moderate weight gain may aggravate the symptoms • Smoking increases the risk of GERD

8. Diagnosis • X-ray of esophagus • Chalky liquid that coats the GI tract and allows physician to see inside of tract and determine damage that has been done. • Endoscopy • Physician passes a flexible tube with a light and camera down the esophagus to view the stomach and esophagus

9. Dietary Interventions • Loose weight if it is needed • Avoid lying down for three hours after eating • Eat frequent and smaller portioned meals • Do not eat close to bed time • Stay away from food that may worsen GERD symptoms: • Citrus fruits, chocolate, caffeine, alcohol, fatty/fried foods, garlic, onions, spicy foods, tomato-based foods

10. Nursing Interventions • Educate 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 interventions • Assist in obtaining resources to help track nutrient/calorie intake • ChooseMyPlate.gov/SuperTracker • https://www.choosemyplate.gov/SuperTracker/default.aspx

11. Medications • OTC: Antacids/any medicine that slows acid production and heals the esophagus • Alka-Seltzer • Prescription 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 GERD

12. Alternative Medications • Not proven to treat or reverse damage, but are proven to provide some relief • Acupuncture • Relaxation Therapy • Guided Imagery • Progressive Muscle Relaxation • Herbal remedies * • Licorice, Slippery Elm, Chamomile, Marshmallow *May interfere with some medications

13. Patient Goals • Maintains a healthy weight • Excess weight creates pressure on abdomen and acid will build up in the esophagus. • Patient avoids food and drinks causing heartburn • Fried foods, fast foods, soda, tomato sauce, onion, garlic, spicy foods, etc. • Eats smaller meals • Obese clients should work towards loosing weight and maintaining a healthier food diet. • Doesn’t lie down after eating • Wait at least three hours to lie down.

14. Outcomes • Weight loss for obese clients • Healthier food diet • Engage in weekly physical activities • Smaller meal portions • Stop/reduce smoking habits

15. Long-Term Implications • Narrowing of the esophagus (esophageal stricture) • An open sore in the esophagus (esophageal ulcer) • Precancerous changes to the esophagus (Barrett’s esophagus)

16. Questions?

17. References • Fennerty, 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.html • Mayo Foundation for Medical Education and Research (MFMER). (1998-2012). Retrieved from http://www.mayoclinic.com/health/gerd/DS00967/DSECTION=lifestyle-and-home-remedies

18. References • Lutz, 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