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GERD Case Study

By: Kaylie Brand and Nicole Preder

www.everydayhealth.com, thoracicsurgeonlosangeles.com
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Introduction

 Think about the foods you typically eat, how often do you consume citrus fruits,
caffeinated, carbonated, or alcoholic beverages, or CHOCOLATE?
 With a gastroesophageal reflux disease (GERD), these foods should be eliminated

 Imagine a life without chocolate...

 It is estimated that 75 million American adults (1 in 5) have GERD symptoms


weekly, and the incidence of the condition has been growing at a rate of 30%
every decade. (Kaechele, 2018)
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Pathophysiology
 Under normal conditions pressure is greater in the
esophagus than in the stomach

 GERD occurs when the LES relaxes/becomes


damaged, pressure is not maintained

 The gastric contents flow upwards

 Pregnant women, obese individuals, and


smokers are at risk

 Diagnosis is based on presence of associated


symptoms and relief after medication, can be
diagnosed further by endoscopy

 If untreated, GERD may impair swallowing, aspiration


of gastric contents in lungs, and perforation of the
esophagus
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Symptoms

 Heartburn

 Chest pain

 Dysphagia (difficulty swallowing)

 Increased salivation

 Belching

 Pain when laying down

Ipohecho.com.my
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Educational Video

https://www.bing.com/videos/search?q=gerd+video&&v
iew=detail&mid=915FCCFE4690483F45BC915FCCFE
4690483F45BC&&FORM=VRDGAR
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Medical Treatment

 Goals of GERD treatment (3)


 Increase lower esophageal sphincter functional ability, decrease gastric acidity, improve
clearance of contents from esophagus

 Medication: (5)
 Proton Pump Inhibitors (PPI) inhibit acid secretions (Omeprazole)

 H2 Blockers block the action of histamine on parietal cells, decreasing the production of
acid (Ranitidine)

 Prokinetics increase the ability for the stomach to contract and shortens emptying time

 Anti-gas agents lower surface tension of gas bubble

 Antacids buffering gastric acid (TUMS)


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Nutrition Therapy
 Goals of treatment = decrease pressure on sphincter and alleviate symptoms

 Avoid large, high-fat meals


 Frequent, small portions
 Avoid ALL fat because it takes longer to digest, healthy fats won't cut it

 Higher protein intake


 Heal esophageal tract

 Consume a healthy, nutritionally complete diet with adequate fiber

 Avoid eating 3-4 hours before bed

 Avoid smoking, alcohol, and caffeinated beverages

 Avoid physical activity right after eating

 Avoid acidic and highly spiced foods

 Lose weight if overweight

dancumberworth.co.uk
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Research

 Aim: to evaluate the clinical outcome of GERD in a population of overweight and obese patients suffering
from this disease in comparison with a control group with normal BMI.

 Materials and Methods: 365 patients diagnosed with GERD were divided into two groups according to
BMI (26->30 = Group 1) and (20-25 = Group 2). These patients were followed up for 10 years with at
least one regular examination every two years with an upper GI endoscopy. GERD symptoms (heartburn,
regurgitation, chronic cough) were recorded by a question are at every visit.

 Results: The percent of esophagitis with the obese BMI group was 52% of people and the percent of
esophagitis in the normal BMI group was only 36%. In all questioner questions the group associated with
the obese BMI claimed to have a higher severity.

 Conclusion: Overweight and obesity are associated with a worse outcome of GERD in a long term
follow up according to endoscopies and severity of symptoms.
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Assessment

48 y/o Indian male recently diagnosed with gastroesophageal reflux disease and hypertension,
recent complaint of indigestion. Abnormal lab values include elevated triglycerides and
cholesterol. Current medications include omeprazole, aspirin, multi-vitamin, and ibuprofen as
needed. Family history of heart disease. Had knee surgery 3 years ago, weight gain of 30 #
since, due to physical inactivity and stress related eating and alcohol drinking problems.
Physical activity is limited to playing with children on the weekends. Lives with his wife and
children, wife does the cooking, if she doesn’t cook patient goes out to eat. Diet history revealed
energy dense foods with large amounts of sugar-sweetened beverages. Patient eats a
combination of traditional Indian foods with American foods, doesn't follow any strict dietary
practices related to his religious background of Hinduism. Patient complained that fried foods
seem to make indigestion worse.

Ht= 60”, Wt= 215#, BMI= 32, UBW= 185#, %UBW= 116%

Recommended energy intake: 98 kg * 20-25 kcal/kg= 1, 960-2,450 kcal/kg (lose weight)

Recommended protein intake: 98 kg * 1.1-1.3 g/kg= 108-127 grams/kg


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Diagnosis

 Undesirable food choices r/t excessive energy intake and lack of


knowledge regarding role of diet in GERD AEB
carbonated/caffeinated/alcoholic beverages and high fat meals.
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Intervention

 RD recommends patient to decrease energy intake by 250 kcal


per day and exercise at least 30 minutes three times a week.
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Nutrition Education

 RD educated patient on importance of physical activity and effects of obesity on


GERD. RD suggested low-impact excercises and gave suggestions of choosing
less high energy snack options that would reduce energy intake to 1960 to 2450
kcal/day.
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Nutrition Counseling

 RD provided counseling on how to exercise safely without putting excess stress


on his knee. Some forms of exercise that the RD suggested were walking,
swimming, biking, and participating in leisure sports. Patient was willing to spend
at least 30 minutes three times a week walking with his family.

 RD counseled patient on choosing lower calorie and fat snack options, for
example having carrots and peppers instead of crackers as an after-work snack.
RD encouraged patient to limit fried foods by packing leftovers from home instead
of ordering out, consume smaller/more frequent meals, and eliminate
carbonated/caffeinated/alcoholic beverages by supplementing with water or low-
fat milk. Patient was willing to pack leftovers for lunch, replace diet Pepsi with
Propel, and limit caffeinated beverage intake after lunch.
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Monitoring and Evaluation

 RD will follow up with patient in 4-6 weeks. RD will M/E weight,


GERD symptoms, and diet history.
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1. Name 2 symptoms common to GERD.


2. True or False: Eating plant-based fats will help eleviate the symtpoms of GERD.

3. Who is most as risk for developing GERD? (3)


4. What sphincter is assocated with GERD?
5. What medication is not assiciated with GERD
a. H2 blockers
b. Proton Pump Inhibitors (PPI)
C. Antigas
d. NSAIDs

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References

Di Mario, F., Savarino, E., Miraglia, C., De Bortoli, N., Franceschi, M., Scida, S., ... & Bertelè, A. (2017). P. 01.14: Overweight
and Obesity as Risk Factors for Gerd Outcome: A 10 Years Study on a Gerd Population of 365 Patients. Digestive and
Liver Disease, 49, e137

Kaechele, J. (2018, January 16). Three facts everyone with GERD should know. Retrieved November 1, 2018, from
https://www.refluxmd.com/three-facts-everyone-gerd-know/

M. (2018, March 09). Gastroesophageal reflux disease (GERD). Retrieved November 1, 2018, from
https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959

Nelms, M. (2019). Nutrition Therapy and Pathophysiology. S.I.:. Cengage Learning.

Preidt, R. (2017, December 21). Chronic Heartburn Tied to Higher Odds for Head, Neck Cancers. Retrieved November 1, 2018,
from https://www.webmd.com/heartburn-gerd/news/20171221/chronic-heartburn-tied-to-higher-odds-for-head-neck-
cancers#1

Williams, W. (2012, December 13). Acid Reflux Aciphex Medical Animation. Retrieved November 1, 2018, from
https://www.bing.com/videos/search?q=gerd
video&&view=detail&mid=915FCCFE4690483F45BC915FCCFE4690483F45BC&FORM=VRDGAR