Gastrointestinal Reflux Disease

Gastrointestinal Reflux Disease

1. Signs & Symptoms

   • Diagnostics
     • Radionuclide Scan:
       • Barium Swallow Gastric Emptying
     • Ambulatory pH monitoring
     • Manometric Studies
     • Esophagogastroduodenoscopy
   • Heart Burn (pyrosis)
     • Burning Tight Sensation felt beneath the lower sternum and spread upward to Throat or Jaw. 
     • mimic Agina
     • More common in Older Adults
   • Dyspepsia
     • Pain felt in the Upper Abdomen 
   • Regurgitation
     • Hot, Bitter or sour liquid come into throat or mouth. Hypersalivation may be reported. 
   • Respiratory
     • Wheezing, Coughing, Dyspnea 
   • Sleep Disruption
     • Nocturnal pain, coughing may awaken patient. 
   • Otarynglogic
     • Hoarsness, Sore throat, globus (lump you cannot swallow), choking. 

2. Complications

   • Barrett's Esophagus
   • Respiratory
     • Cough, Bronchospasm, Laryngospasm, Cricopharyngeal Spasm
   • Dental
     • Teeth Erosion
   • Esophagitis
   • Strictures

3. Interventions

   • Lifestyle
     • Weight Reduction
     • Diet & Drugs that effect LES
     • STOP smoking
     • Cope with Stress
   • Foods to avoid
     • Chocolate
     • Pepperment
     • Tomatoes
     • Fatty Foods
     • Coffee & Tea
   • Drugs
     • Lewis page 934
     • Proton Pump Inhibitor
       • Headache
       • Longterm Use Increase Risk of Fracture: Hip/wrist/spine
       • Increase Risk of C-difficile
     • Histamine blocker
     • Prokinetic Agents
       • Promote Gastric Emptying
     • Antiulcer Protectant
     • Cholinergic
       • Increase LES pressure, Improve esophageal emptying and increase Gastric Emptying. "Rest & Digest" increased. 
     • Antacid Neutralizer
       • Take 1-3hrs after meals/' Quick short lived. 
     • Prostagladins
   • Nursing Management
   • Endoscopy
     • Esophageal mucosal Resection
     • Photodynamic Therapy
     • Cryotherapy
     • Radiofrequency Albation
   • Surgical
     • Medication intolerance
     • Barrett's Metaplasia
     • Esophageal Strictures/stenosis
     • Nissen & Toupet Fundoplication
       • Fundus of stomach wrapped around distal esophageal and Sutured to itself. 
     • LINX reflux management System
       • Titanium Beads with a core strung together and implemented laproscopically. Resting conditions the string tightens and opens when the pt. swallows.
       • NO MRI
       • Adverse Effects: Difficulty swallowing, N&V, chest pain
   • Nutrition
     • Decrease High Fat foods
     • Take fluids between rather than with meals
     • Avoid Milk at night
       • Increase Gastric Acid secretion
     • Avoid Late Night Snacking
     • Eat Small Frequent Meals
       • Avoid overdistention
     • Use Chewing Gum or ORAL Lozenges
       • Increases Salivia

4. Stomach Contents Erode the Esophagus Mucosal Lining