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Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease or GERD occurs when the reflux of stomach acid and contents has a “reflux” back into the esophagus.

  • This is usually caused due to the weakness within the lower esophageal sphincter or LES.
  • This acid, can affect the lining of the esophagus and eventually cause pain to the patient.

Assessment:

  • Dysphagia
  • HeartBurn (burning and stinging sensation in the upper midsternum.
  • Belching (eructation)
  • Flatulence
  • Chest Pain

Diagnostic Tests:

  • pH Monitoring is one of the accurate diagnostics (NG tube is used)
  • A pH of less than 4 in the LES is a diagnosis of GERD
  • Endoscopy
  • Barium Swallow

Management:

  • Avoid food that are irritants such as (spicy foods, chocolate, fats)
  • Small frequent meals
  • Not lie down 2-3 hours after eating.
  • Avoid Alcohol

Medications:

  • Antacids (Mylanta)
  • Proton Pump Inhibitors (Protoix, Nexium)
  • Histamine Blockers (Pepcid, Axid)
  • Prokinetic Drugs (increases gastric emptying) (Reglan)

Procedures:

Stretta- inhibits the vagus nerve activity in the GI system.

♣ Laproscopic Nissen Fundoplication (LNF)– fundus of the stomach is wrapped around the esophagus to support the LES.

♣ Post Op:

  • Elevate the head of bed to prevent respiratory problems.
  • Monitor the NG tube

After the procedure: the stomach size is smaller.

– Long term reflux of the acid in GERD patients can cause   Barrett’s Esophagus.

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