Gastroesophageal Reflux Disease
Original Editors - Tessa Puckett from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
Gastroesophageal reflux disease (GERD), sometimes referred to as esophagitis, is a condition that results from reflux (backward flow) of the stomach contents into the esophagus. Reflux of infectious agents, chemical irritants, physical agents such as radiation and nasogastric intubation can cause GERD and can irritate and inflame the esophagus causing heartburn, belching, sore throat and other symptoms. Heartburn and indigestion are not other words for GERD, but are common symptoms of the condition. [1][2][3]
[Photo courtesy of the National Center for Biotechnology Information, U.S. National Library of Medicine. Available at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/figure/d19e2114/?report=objectonly.]
Prevalence[edit | edit source]
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Characteristics/Clinical Presentation[3][2][edit | edit source]
Common Symptoms:
- Heartburn
- Bitter/sour taste in the back of the throat
- Abdominal bloating/Abdominal discomfort
- Gas
- Chronic Cough
- Feeling the food is trapped behind the breastbone or in the throat
- Nausea after eating
- Burning sensation that begins at the xiphoid processs and radiates up toward the neck
- Intense sharp pain behind sternum with radiation to the back
Associated Co-morbidities[edit | edit source]
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Medications[2][edit | edit source]
Medications used to treat symptoms of GERD include: Antacids, Histamine 2 Receptor Blockers, and Proton Pump Inhibitors.
Antacids
- Neutralizes the acid
- Does not reduce it (same amount of acid is produced)
- Available over the counter, do not require a prescription
- Includes Mylanta, Maalox, Tums, Rolaids
File:Mylanta.jpgFile:Tums.jpgFile:Rolaids enlarge1.jpg
Histamine-2 Receptor Blockers
- Reduce stomach acid produced by the stomach
- Some are sold over the counter
- Over the Counter H2 Blockers: Pepcid, Zantac, Tagamet, and Axid
File:Pepcid.jpgFile:Zantac.jpg
Proton Pump Inihibitors
- Most potent acid-suppressing agent
- Stops acid from forming, instead of neutralizing it
- Some PPI's are sold over the counter
- Use caution when used without medial supervision
- PPI's can mask more serious conditions in the esophagus and stomach
- Over the counter PPI's: Prilosec (omeprazole) and Zegerid
- PPI's requiring a prescription: Prevacid, Protonix, Nexium (esomperalzole), and Aciphex
File:Prilosec.jpgFile:Nexium.jpgFile:Zegerid-rebate.jpg
People taking the above listed medications should report to the doctor if they have complaints of headache, constipation, diarrhea, abdominal pain, or dizziness.
It is essential for the physical therapist to take note of the patient's medications; listen for complaints of headache, constipation, diarrhea, abdominal pain and dizziness; and report those findings to the doctor.
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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Etiology/Causes[edit | edit source]
- Lower Esophageal Sphincter (LES) Dysfunction[3]
The LES is a ring of muscle fibers that functions to close the opening between the esophagus and the stomach. When the LES is not functioning properly, the stomach contents (food, liquid, and stomach acid) can move backward into the esophagus causing damage to the esophagus. The backward flow of food from the stomach into the esphophagus is called reflux.
- Obesity
- Smoking
- Alcohol
- Medications [3]
Several medications can cause GERD or make it worse
Nonsteroidal anti-inflammatory drugs (NSAID's): Advil (ibruprofen), Motrin, Aleve
Medication Class: Example Medication
Anticholinergics: Bentyl
Beta Blockers: Toprol XL
Bronchodilators: Advair
Calcium Channel Blockers: Norvasc
Hormone Replacement Therapy: Progesterone
Sedatives: Valium, Xanax
Tricyclic Antidepressants: Doxepin
Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
Shakers Head Lift Exercise PDF Handout from The Ohio State University Medical Center Department of Rehabilitation Services - Dodd Hall[4]
Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
Chronic gastroesophageal reflux disease and its effect on laryngeal visualization and intubation: a case report. [5]
A Randomized Study Comparing the Shaker Exercise with Traditional Therapy: A Preliminary Study [6]
Resources
[edit | edit source]
National Institue of Health MedlinePlus: http://www.nlm.nih.gov/medlineplus
National Digestive Disease Information Clearinghouse:http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
eMedicine Health: http://www.emedicinehealth.com
International Foundation for Functional Gastrointestinal Disorders: http://www.aboutgerd.org/
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
see adding references tutorial.
- ↑ Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis: Saunders Elsevier; 2009.
- ↑ 2.0 2.1 2.2 Goodman, Snyder. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th Ed. Philadelphia: WB Saunders; 2003.
- ↑ 3.0 3.1 3.2 3.3 National Center for Biotechnology Information, U.S. National Library of Medicine. Gastroesophageal reflux disease. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/ (accessed 17 March 2011).
- ↑ The Ohio State University Medical Center Department of Rehabilitation Services - Dodd Hall. Exercises to Improve Swallowing. http://medicalcenter.osu.edu/PatientEd/Materials/PDFDocs/dis-cond/general/exercises-swallowing.pdf (accessed 31 March 2011).
- ↑ Stevens L. Chronic gastroesophageal reflux disease and its effect on laryngeal visualization and intubation: a case report. AANA Journal [serial on the Internet. (2002, Oct), [cited March 17, 2011]; 70(5): 373-375. Available from: MEDLINE.]
- ↑ Logemann, JA, Rademaker, A, Pauloski, BR, et al. A Randomized Study Comparing the Shaker Exercise with Traditional Therapy: A Preliminary Study. Dysphagia. [serial on the Internet. (2009 December), [cited March 31, 2011]; 24(4): 403–411. Available from: PubMed.]