Gastroesophageal

Reflux Disease
(GERD)
Madilyn Sheerer
Introduction
One of the most prevalent esophageal diseases
Affects a large population in developed and developing countries
Up to 20% of people living in developed countries are estimated to be affected by
GERD
One of the top 10 reasons to seek medical care
Association between obesity and GERD
Lifestyle contributes:
Overeating
Fast eating
Gluten sensitivity and celiac disease have an increased risk
 What is GERD? Gastroesophageal reflux occurs
when contents in the stomach flow back into the

Etiology
esophagus. This happens when the valve between the
stomach and the esophagus (the lower esophageal
sphincter) does not close properly.

The risk factors include:

Obesity
Bulging of top of stomach up into the
diaphragm (hiatal hernia)
Pregnancy
Smoking
Dry mouth
Asthma
Diabetes
Delayed stomach emptying
Connective tissue disorders (such as
scleroderma)
Symptoms
Acid regurgitation Symptoms can also be caused by certain
Difficulty or pain when medicines, such as:
swallowing Anticholinergics (Seasickness medicine)
Sudden excess of saliva Bronchodilators for asthma
Chronic sore throat Calcium channel blockers for high blood
Laryngitis or hoarseness pressure
Dopamine-active drugs for Parkinson disease
Inflammation of the gums Progestin for abnormal menstrual bleeding or
Cavities birth control
Bad breath Sedatives for insomnia or anxiety
Chest pain Tricyclic antidepressants
Nutrition Diagnosis/PES
Altered Gastrointestinal (GI) Function (NC-1.4) related to alteration in
gastrointestinal tract structure and/or function as evidenced by

Indigestion related to regular consumption of high fat foods, fried

foods, and alcohol as evidenced by diet history, 24 hour recall, and
diagnosis of GERD.
Nutrition Treatment

Small frequent meals

Regular meal patterns
Chew food well and slow
Reduce fatty, fried foods
Increase fruits and vegetables
Avoid foods that cause discomfort
 Foods Not Recommended
Avoid eating or drinking the following items that may make GERD worse:

Chocolate
Coffee
Peppermint
Spicy foods
Tomatoes and tomato products
Alcoholic drinks
High-fat foods, including:
a. Whole milk, cream, high-fat cheese
b. Fried meats (bacon, sausage, pepperoni)
c. Other fried foods (doughnuts, french fries)
d. Pastries and other high-fat desserts
e. More than 8 teaspoons of oil, butter, shortening per day
Any fruits or vegetables that cause symptoms
 Foods to Include in a GERD-Friendly Diet
The goal is to create a diet that consists of a variety of healthful foods, such lean protein, complex
carbohydrates, and fruits and vegetables. Try incorporating the following foods and drinks:

Beverages Fruits and Vegetables Healthy Fats

nonfat or low-fat milk all vegetables with little nuts and seeds
non-mint herbal teas added fat low-fat salad dressings
non-citrus juices non-citrus fruits small amounts of olive,
sesame, vegetable, and
Carbohydrates Protein sunflower oils
rice lean meat, such as chicken
plain pasta and fish Desserts
oatmeal low-fat dairy angel food cake
whole-grain bread beans and lentils low-fat ice cream
low-fat cereals peas sherbet
crackers tofu frozen yogurt
pancakes and waffles eggs
boiled potatoes nut butter
 Sample Menu
Breakfast: Afternoon Snack:
1 cup cooked old-fashioned oatmeal cup low-fat cottage cheese
2 tablespoons raisins Cantaloupe chunks
1 medium banana
Dinner:
1 cup skim milk
Lunch: 1 cup romaine and spinach mix
2 slices whole wheat bread 3 oz cooked turkey, chopped
3 oz shredded chicken breast Low-fat cheese
2 tbs low-fat mayonnaise Broccoli
1 medium apple Carrots
1 cup skim milk Cucumbers
Low-fat dressing
1 medium peach topped with cinnamon
 Recipe: Breakfast Bars (makes 12 bars: 1 bar= 1
serving)

Ingredients:
3 mashed bananas (ripe)
cup apple sauce
2 cups old-fashioned oats
cup almond milk
cup raisins
tsp baking soda
1 tsp vanilla
1 tsp cinnamon
Labs and Parameters
Labs:
Ambulatory acid (pH) probe tests use a device to measure acid for 24 hours.
Normal esophageal pH is considered to be close to pH 7.0.
Definition of gastroesophageal reflux during pH monitoring is a sudden decrease in
intraesophageal pH to below 4.0

Tests:
X-ray of your upper digestive system or barium swallow
Endoscopy
Esophageal motility testing
Medications
Antacids H2 blockers Proton pump inhibitors
Maalox cimetidine (Tagamet HB) esomeprazole (Nexium)
Mylanta famotidine (Pepcid AC) lansoprazole (Prevacid)
Riopan omeprazole (Prilosec, Zegerid)
nizatidine (Axid AR)
Rolaids pantoprazole (Protonix)
ranitidine (Zantac 75) rabeprazole (AcipHex)
 Lifestyle Tips
Exercise at least three or four times a week
Do not exercise right after eating a meal
Wear loose-fitting clothes
Do not smoke
Raise the head of your bed 6 to 9 inches
Wait 3 hours after eating before lying down
Eat several small meals throughout the day
Eat in a calm, relaxed place. Sit down while
you eat
Fun Quiz
Which of these foods should you avoid if you have GERD?

a.Lean meat

b.Pancakes

c. Tomatoes

d.Crackers
Answer:
c. Tomatoes
Fun Quiz
All of the following lifestyle habits will aid in the symptoms of GERD
except?

a.Exercise right after eating a meal

b.Eating 3 hours before laying down

c. Eat several small meals throughout the day

d.Wear loose clothing

Answer:
a. Exercise right after eating a meal
Fun Quiz
True/False:

GERD occurs when contents in the stomach flow back into the
esophagus?

Answer:
True
 References
American Dietetic Association. Nutrition Care Manual. Gastroesophageal Reflux Disease (GERD) Nutrition Therapy.
https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=165&actionxm=ViewAll. Accessed 19 September 2016.

Esmaillzadeh, A., Keshteli, A. H., Feizi, A., Zaribaf, F., Feinle-Bisset, C., & Adibi, P. (2013). Patterns of Diet-Related Practices and
Prevalence of Gastro-Esophageal Reflux Disease. Neurogastroenterology & Motility, 25(10), 831-e638. Doi: 10.1111/nmo.12192

GERD Tests and diagnosis - Mayo Clinic. (n.d.). Retrieved from http://www.mayoclinic.org/diseases-conditions/gerd/basics/tests-
diagnosis/con-20025201

Galland, L. (2012). GERD as a Motility Disorder: A New Way of Thinking. Alternative & Complementary Therapies, 18(6), 292-296.
doi:10.1089/act2012.18605

Kubo, A., Block, G., Quesenberry, C. J., Buffler, P., & Corley, D. A. (2014). Dietary guideline adherence for gastroesophageal reflux
disease. BMC Gastroenterology, 14144. doi:10.1186/1471-230X-14-144

McCulloch, M. (2016). Dietary Relief from GERD. Environmental Nutrition, 39(4). 4.

Tutuian, R., & Castell, D. O. (206, May 16). Gastroesophageal reflux monitoring: PH and impedance. GI Motility Online.
doi:10.1038/gimo31