Nutrition (Week #6)

Esophagus and Alterations in Nutrition: PUD & GERD

Introduction

  • NUR 1020: Course focusing on the nursing considerations regarding alterations in nutrition, particularly concerning Peptic Ulcer Disease (PUD) and Gastroesophageal Reflux Disease (GERD).

Student Learning Objectives

  1. Discuss Risk Factors

    • Identify modifiable and non-modifiable risk factors for developing selected nutritional disorders.

  2. Clinical Manifestations

    • Recognize common clinical manifestations of altered nutrition.

  3. Patient Care Planning

    • Develop a plan of care for patients with altered nutrition.

  4. Nutritional Delivery Systems

    • Compare guidelines and nursing interventions for alternative nutritional delivery systems, including enteral and parenteral nutrition.

  5. Treatment Options

    • Discuss common treatment options for patients with selected disorders.

  6. Pharmacologic Therapies

    • Integrate knowledge of common pharmacologic therapies into patient care related to altered nutrition.

Gastroesophageal Reflux Disease (GERD)

Definition

  • Chronic Syndrome: Characterized by mucosal damage due to the reflux of stomach acid into the lower esophagus.

Etiology and Pathophysiology

  • Acidic Gastric Contents: Overwhelm esophageal defenses leading to irritation and inflammation.

  • Primary Factor: Incompetent Lower Esophageal Sphincter (LES).

  • Factors Affecting LES Pressure: Food, medications, obesity, smoking, and hiatal hernia influence the effectiveness of the LES.

Clinical Manifestations of GERD

  • Heartburn (Pyrosis): Most common symptom; described as a burning, tight sensation under the lower sternum, spreading into the throat or jaw, often mimicking angina but relieved with antacids.

  • Dyspepsia: Pain or discomfort in the upper abdomen.

  • Regurgitation: Presence of hot, bitter, or sour liquid in the mouth or throat.

  • Respiratory Symptoms: Wheezing, coughing, dyspnea, nighttime disturbances, hoarseness, sore throat, lump in throat feeling, choking, and increased saliva production.

Complications of GERD

  • Esophagitis: Inflammation of the esophagus.

  • Ulcerations: Can lead to scar tissue, stricture, and dysphagia.

  • Barrett’s Esophagus (BE): A condition that results in metaplasia of cells, increasing the risk of esophageal cancer.

  • Respiratory Complications: Cough, bronchospasm, laryngospasm, and cricopharyngeal spasm. Aspiration into the respiratory system can lead to asthma, chronic bronchitis, and pneumonia.

  • Dental Erosion: Due to acid exposure from reflux.

Diagnostic Studies for GERD

  • Common Studies: Diagnosed based on response to behavioral and drug therapies, along with the patient's history and physical examination.

  • Upper GI Endoscopy: With biopsy and cytologic analysis to assess for mucosal changes.

  • Esophagram (Barium Swallow): Visualizes the esophagus and identifies reflux.

  • Motility Studies: Evaluate esophageal motility (manometry).

  • pH Monitoring: Assesses esophageal acid exposure.

  • Radionuclide Studies: Can also be utilized as part of diagnostic workup.

Nursing and Interprofessional Management for GERD

Lifestyle Modifications

  • Patient and Caregiver Teaching: Implement strategies to help manage GERD symptoms.

  • Dietary Guidelines: Encourage a low-fat diet and small, frequent meals.

  • Avoidance: Alcohol, caffeine, tight clothing, and bending over after meals should be restricted. Eating should not occur within 3 hours of bedtime.

  • Posture: Maintain an upright position for 2-3 hours after meals. Elevate head of bed by 4-6 inches to decrease nocturnal symptoms.

  • Weight Management: Promote weight loss for obese patients.

Drug Therapy

  • Goal: Decrease volume and acidity of reflux, improve LES function, increase esophageal clearance, and protect esophageal mucosa.

  • Common Medications:

    • Proton Pump Inhibitors (PPIs): (e.g., Omeprazole, Pantoprazole) decrease HCl secretion, are most effective for healing esophagitis and preventing strictures; complications may include reduced bone density, kidney disease, vitamin B12 and magnesium deficiencies, and increased dementia risk.

    • H2 Receptor Blockers: (e.g., Cimetidine, Famotidine) decrease HCl secretion; onset 1 hour with a duration of up to 12 hours. Available in oral, IV, and combinations with antacids.

    • Antacids: (e.g., Aluminum Hydroxide, Calcium Carbonate) for immediate symptom relief; used cautiously in certain populations.

    • Prokinetics: Increase gastric motility and emptying but associated with potential CNS side effects.

Nutritional Management for GERD

  • Dietary Guidelines: There is no specific diet; however, foods that decrease LES pressure or irritate the esophagus should be avoided. Consider restricting milk consumption