3. Gastroesophageal Reflux
Disease: Introduction
GERD:
A condition that occurs when the
refluxed stomach
contents lead to troublesome
symptoms and/or
complications
is a chronic disorder resulting from
the retrograde flow of
gastroduodenal contents into the
esophagus or adjacent organs, and
3
4. GERD….
• Signs and symptoms
–Heartburn
–Indigestion
–Belching:(also known as burping, ructus, or
eructation) involves the release of gas from the
digestive tract (mainly esophagus and stomach)
through the mouth.
–Hiccups- a spasm of the diapphram
–Regurgitation of gastric contents
bitter, acidic test in the mouth when lying down
or bending over
4
5. • Primary barrier to
gastroesophageal reflux is the
lower esophageal sphincter
(LES).
• LES normally works in conjunction
with the diaphragm
• If barrier disrupted, acid goes from
6.
7.
8. GERD…
• Triggers
–Eating large meals
–Certain medications
–High-fat foods
–High caffeine intake
–Alcohol and tobacco use
–Reclining (bending back) after
eating 8
13. GI drugs—GERD…H2 blockers
• They decrease the acidity of
esophageal reflux.
• Believed to decrease mucosal
damage & discomfort.
• Concerns with this treatment are
that gastric acidity may play a role
in host immune defense. ? ^ risk
of late onset sepsis,
• Decreasing acid production may
14. GI Drugs-GERD….
2. Proton pump inhibitors
(PPIs).
• Powerful blockers of gastric
acid secretion.
• Irreversibly reverse the gastric
H+/K+ adenosine
triphosphatase responsible for
secreting H+ into gastric lumen.
15. GI Drugs-GERD….PPI
• Presently off label use in neonates
and infants less than 1 year.
• Many of the same concerns as H2
blockers.
• In one study, nonsignificant
increased incidence of lower
respiratory infections.
• Also concern for bone fractures.
16. GI Drugs-GERD….
3. Prokinetics.
• Drugs that promote gastrointestinal motility.
• Believed to decrease GER by increasing
gastric emptying thus, limiting amount that of
liquid available to reflux.
• May also improve esophageal motility &
lower esophageal sphincter tone
• Exs: Metoclopramide (Plasil)). is a
dopamine D2
receptor antagonist.
• Crosses blood brain barrier & may see
17. GI Drugs-GERD…. Prokinetics
• Erythromycin also increasing
gastric emptying by promoting
GI migrating motor complexes.
Uses doses less than
w/antibiotics.
May increase concentration of
other drugs.
Arrhythmias.
20. Difficulty or painful defecation
Stool frequency <3 times per week
Hard stool
ineffective defecation/
‘sense’ of incomplete evacuation
“straining”
24. hiding behind furniture or
in the corner
rock back and forth
contract anus & gluteal
muscle
cross their legs and buttocks
stiffly.
rise up on their toes,
Toddlers
28. BULK-FORMING LAXATIVES
• indigestible, hydrophilic colloids that
absorb water
• forming a bulky, emollient gel
• distends the colon and promotes
peristalsis
• increased bloating and flatus.
29. STOOL SOFTENERS
• soften stool material, permitting
water and lipids to penetrate.
• not palatable but may be mixed
with juices.
• Impair absorption of fat-soluble vitamins
(A, D, E, K).
30. OSMOTIC LAXATIVES /PURGATIVES/
• soluble but nonabsorbable compounds
that ↑stool liquidity due to an obligate ↑
fecal fluid in the colon.
• High doses; produce prompt bowel
evacuation within 1–3 hours.
• Magnesium hydroxide( MoM)
-should not be used for prolonged
periods in patients with renal
insufficiency :hypermagnesemia.
• Sorbitol and lactulose
31. STIMULANT LAXATIVES Cathartics/
• Direct stimulation of colonic
electrolyte and fluid secretion.
• cause water evacuation in 1 to 6
hours
Examples: Aloe, senna, cascara,
castor oil, bisacodyl( as tablet
and suppository)
• dependence
32. Laxatives: Side Effects
• Bulk forming
– increased bloating and flatus
– Fluid overload
• Emollient
– Skin rashes
– Decreased absorption of fat-soluble substances vitamins
(such as A,D,E,K)
• osmotic
– Abdominal bloating
– Rectal irritation
