Upper GI Tract 1. Gastroesophageal Reflux Disease (GERD) Chronic digestive disease- occurs when stomach acid or stomach content flows back into the esophagus. Possible causes: <book> incompetent lower esophageal sphincter pyloric stenosis hiatal hernia* motility disorder Risk factors: <book> Aging irritable bowel syndrome obstructive airway disorders (asthma, COPD, cystic fibrosis) peptic ulcer disease angina tobacco, alcohol, coffee overweight gastric infection with Helicobacter pylori. Symptoms: pyrosis (heartburn or burning sensation in the esophagus) o contact physician if… heartburn gets worse heartburn 2 or more times a week wakes you from sleep pain when swallowing pain interferes with ADLs belching difficulty when swallowing/pain chronic sore throat/ hoarseness laryngitis inflamed gums/eroding enamel sour taste/bad breath dysphagia (feeling of food sticking to esophagus) water-brash (hyper-salivation) dyspepsia (indigestion) regurgitation chest pain *may mimic those of a heart attack.
Complications: <book> dental erosion ulcerations in the pharynx and esophagus laryngeal damage esophageal stricture adenocarcinoma pulmonary complications Treatment/ Management: Goals: 1. Get symptoms under control; get individual to feel better 2. Heal esophagus 3. Manage/prevent complications (Barret’s esophagus or stricture) o Barrett’s: BE is a condition in which the lining of the esophageal mucosa is altered. Squamous mucosa changes to a columnar-lined epithelium that resembles the intestines. BE is the only known precursor to esophageal adenocarcinoma (EAC). o Stricture: narrowing or tightening of esophagus Medications: Control symptoms; underlying disease remains present long-term meds 1. H2 Blockers Reduce the amount of acid produced in the stomach. Eliminate symptoms and allow esophageal healing in 50% Remission is retained in only 25% of people 2. Proton Pump inhibitors *better Limit acid secretion in stomach. Rapid resolution of symptoms and esophageal healing in 80-90% Manage stricture 3. Antacids Nutritional therapy: 6 small meals a day avoid: coffee, alcohol, caffeine, milk, mint, carbonated beverages Eat slowly No evening snacks Don’t lie down within 3 hours of eating; don’t drink 2 hours before bed Experiment (what foods exacerbate symptoms?)
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- Fall '16
- Denise Cauble
- Nursing, chronic diarrhea, Bowel obstruction, pyrosis