UNM COC:  Your Healthcare Primer for Long Term Care

 
Gastroesophageal Reflux Disease (GERD)

Sharon Witemeyer MD (Pediatrician)

Definition

Any condition or tissue change that results from the backup of gastric (stomach) contents into the esophagus.

Introduction

Gastroesophageal reflux is a normal condition that occurs in the daytime, especially after meals. However, about seven million Americans suffer from gastroesophageal reflux disease (GERD) which is caused by an incompetent lower esophageal sphincter that allows acidic stomach contents to enter the esophagus. The stomach lining is protected from the effects of its own acid but the esophagus is not so when acid refluxes into the esophagus it causes pain, inflammation and damage to the tissues. Individuals with developmental disabilities are even more likely than the general population to suffer from GERD. Because many of these individuals are non-verbal, they may not be able to describe the typical symptoms. 

Common symptoms of GERD in this population include:

1. Heartburn - a burning pain under the breastbone

2. Belching

3. Regurgitation of food

4. Nausea or vomiting

5. Hoarseness or a voice change

6. Sore throat or difficulty swallowing or earache

7. Pulmonary symptoms such as coughing or wheezing

8. Weight loss or weight gain

9. Behavior problems

10. Dental symptoms like tooth decay, gingivitis, halitosis

Complications of GERD include:

1. Esophageal erosions, ulcers or strictures

2. Change in the tissue (Barrett's epithelium) which can precede cancer

3. Bleeding

4. Anemia

5. Aspiration pneumonia

Diagnosis

The symptoms of GERD listed above usually point to the diagnosis. Often the physician will suspect the diagnosis on the basis of symptoms and give the individual a therapeutic trial of anti-reflux medication to confirm the diagnosis. Tests which may be preformed to make the diagnosis include a stool guiac test for blood, a barium swallow with upper GI (X-ray), continuous esophageal pH monitoring, esophageal manometry (pressure measurements), or esophagoscopy (looking at the esophagus through a flexible viewing tube) and biopsy (taking a tissue sample.)

Treatment

1. Simple measures (lifestyle and environmental changes)

   1. Elevate the head of the bed about 6 inches

   2. Avoid food and fluid intake before bedtime and remain upright for 30-60 minutes after eating

   3. Avoid cigarettes, coffee, alcohol, chocolate, peppermint

   4. Avoid tight clothing around the waist

   5. Take antacids 1 hour after meals, before bedtime and prn

   6. Reduce fat in diet and lose weight

2. Medication

   1. Cimetidine (Tagamet)

   2. Ranitidine (Zantac)

   3. Famotidine (Pepcid)

   4. Iansoprazole (Prevacid)

   5. Metoclopramide (Reglan)

   6. Omeprazole (Prilosec)

3. Antireflux surgery - Nissen fundoplication

Emergency Situations – What can go wrong?

GERD is a chronic condition and acute emergencies are rare. The one significant and acute risk is aspiration.

Conclusion

GERD is caused by an incompetent esophageal sphincter which allows stomach acid to backup into the esophagus. It is very common among all populations in America and especially common among individuals with developmental disabilities. The most common symptom of GERD is heartburn. Other symptoms include belching, regurgitation of food, nausea, vomiting, hoarseness, sore throat, earache, coughing, wheezing, change in weight, behavior problems or dental problems. Although lifestyle and environmental changes are helpful to some individuals there is little data to support their efficacy. Medical treatment is available and can be prescribed by a physician. Untreated GERD can lead to esophageal bleeding, anemia, esophageal erosions, ulcers, strictures, precancerous changes in the esophagus, chronic pain syndrome, irritability, agitation, abnormal positioning and  aspiration.

Sharon Witemeyer MD (Pediatrician)