A walking toolkit to promote activity and health reflux ...1].pdf · Gastro-oesophageal reflux...

Last reviewed: October 2011Leaflet reference: PHD11-001-CC

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Gastro-oesophageal reflux disease (GORD)Information for carers and care support workers of people with learning disabilities

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A walking toolkit to promote activity and health for people with a learning difficulty

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This leaflet aims to raise awareness of GORD and give advice to reduce the related symptoms.

GORD and people with learning disabilitiesGastro-oesophageal reflux disease (GORD) is sometimes described as heartburn or indigestion (a burning sensation in the chest, just behind the breastbone).

GORD is a very common digestive condition. It is estimated that 48 per cent of people with a learning disability will have GORD. This is significantly higher than the general population. As this condition is frequently overlooked, particularly in those unable to communicate their pain, the number of people experiencing GORD could be much higher.

People with a severe learning disability who are unable to communicate their symptoms may have an increased risk of oesophagael cancer compared to the general population. It is thought that the amount of untreated GORD conditions in this population could be related to this increased risk.

However, GORD is highly treatable. This leaflet contains tips to help reduce the symptoms of GORD.

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What is GORD?

GORD occurs when stomach acid leaks back up into the oesophagus. This is known as acid reflux. The oesophagus is the “food” tube that runs from your throat to your stomach.

The muscle relaxes to let food into your stomach, and it closes to prevent any acid leaking back up into the oesophagus.

However, in people with GORD, the muscle can become weakened, allowing stomach acid to pass back into the oesophagus, causing pain and discomfort.

Notes

Inflammation is here, where acid refluxes from the stomach

Liver

Oesophagus (gullet)

Lower oesophagus sphincter

Stomach acid forms here

Stomach acid forms here

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In many cases of GORD, there is no reason why a person has developed the condition.

Repeated episodes of GORD can make the lining of your oesophagus inflamed (known as oesophagitis).

Symptoms of GORD The two most common symptoms of GORD are:

Heartburn - a burning sensation •that rises from your stomach, or lower chest, up towards the throat

Regurgitation - acid in the throat, •or mouth, which may cause an unpleasant sour taste in the mouth

These symptoms usually occur after a large meal or at night and may feel worse when a person is lying flat.

If the person you care for is unable to communicateThere are also some more obvious signs and symptoms that can be seen if the person is unable to communicate to you, for example:

The contact details for each of the referral schemes are below:

South Ayrshire, Activity for Health •( 01292 294716)

East Ayrshire, Community Health Improvement •Partnership ( 01563 576689)

North Ayrshire, Active North Ayrshire •( 01294 605128)

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weight loss •

excess oral secretions•

respiratory problems (chronic cough - •particularly at night)

wheezing, shortness of breath•

refusal to eat•

change in sleep pattern •

Risk factorsThere are a number of possible risk factors which are known to increase the likelihood of developing GORD. These are outlined below:

Being overweight• or obese increases the pressure on the stomach

A diet that is high in fatty foods• - the stomach takes longer to empty after digesting a fatty meal

Smoking, alcohol, coffee, and chocolate• can relax the muscle which is situated at the bottom of the oesophagus

For help to stop smoking contact:Fresh Air-shire on 0800 783 9132•

Local leisure servicesIn each local authority, leisure services provide activity referral pathways which are available to people who may benefit from regular, moderate physical activity (for example, someone who is overweight or obese, stressed, a smoker or consumes more than the recommended amount of alcohol). The person you are caring for can be referred to these services by their family doctor (GP), practice nurses, midwives, health visitors, hospital, physiotherapist, mental health professional, community pharmacy, smoking cessation officer and dietitians.

Before starting any physical activity a member of the fitness team will meet with the individual to have a confidential discussion about suitable activities. This may be an activity such as aqua trim, cardiac rehabilitation classes, keep fit for beginners, pilates, swimming, Tai-Chi, walking or a simple home-based exercise.

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Stress•

Taking certain medications• - such as:

Anticholinergic - for example, ipratropium for respiratory disease, hyoscine for some gastro-intestinal disorders

Calcium channel blockers – for example, amlodipine, diltiazem

Benzodiazepines – for example, diazepam, temazepam

Nitrates – for example, glyceryl trinitrate (GTN), isosorbide mononitrate

Other causes:

Being pregnant• - the changes in hormone levels that occur during pregnancy can weaken the muscle which is situated at the bottom of the oesophagus. Pregnancy can also increase the pressure on the stomach.

Having a hiatus hernia• - hiatus hernia is where part of the stomach pushes up through the diaphragm (a muscle that is used for breathing).

What should I do? If you think the person you are caring for is experiencing any of the symptoms mentioned in this booklet, please encourage and support them to visit their family doctor (GP) to tell them about these symptoms.

If the person is currently taking medication for any other health conditions, the doctor should be asked if these could be increasing the symptoms of GORD. Alternative medicines may be available. Do not stop any medication without speaking to a doctor.

Further advice and supportTelephone NHS 24 on 08454 24 24 24•

South Ayrshire, Community Learning Disability •Team: ( 01292 614910)

North Ayrshire, Community Learning Disability •Team: ( 01294 323560)

East Ayrshire, Community Learning Disability •Team: ( 01563 578567)

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Healthy eatingThe main cause of GORD is being overweight, as this increases the pressure on the stomach. If overweight, losing weight may help to reduce the symptoms.

If you are unsure whether the person you care for is overweight or you feel they would benefit from weight management advice please encourage them to see their family doctor (GP).

Following the 'Eatwell' plate can help when trying to lose weight. This makes healthy eating easier to understand by showing the types and amounts of foods we need to have a healthy and well balanced diet.

Tips for reducing symptomsTry smaller, more frequent meals rather than •three large meals a day. Make sure that the evening meal is eaten three to four hours before going to bed

Try cutting down on foods high in fat• - this combined with physical activity will also help to lose weight

Avoid• lying down after eating a meal

Watch for triggers that make •GORD worse - for example, alcohol, coffee, chocolate, tomatoes, soft drinks containing caffeine or fatty (or spicy) foods. Once triggers are identified, try removing them from the diet and see whether the symptoms improve

If a smoker, try to cut down or stop• . Tobacco smoke can irritate the digestive system and may make the symptoms of GORD worse

Try to take time for relaxation• to reduce stress - for example, Tai Chi (Chinese martial art), listening to relaxation music, physical activity

Antacids or medication may be helpful• but this should be discussed with a pharmacist or doctor first

Anticholinergic - for example, ipratropium for respiratory disease,

hyoscine for some gastro-intestinal disorders

Calcium channel blockers – for example, amlodipine, diltiazem

Benzodiazepines – for example, diazepam, temazepam

Nitrates – for example, glyceryl trinitrate (GTN), isosorbide mononitrate

Other causes:

Being pregnant - the changes in hormone levels that occur during

pregnancy can weaken the muscle which is situated at the bottom of the

oesophagus, it can also increase the pressure on your stomach.

Having a hiatus hernia - hiatus hernia is where part of the stomach

pushes up through the diaphragm (a muscle that is used for breathing).

Healthy Eating

The main cause of GORD is being overweight as this increases the pressure on

the stomach. If overweight, losing weight may help to reduce the symptoms.

If you are unsure whether your client is overweight or you feel your client would

benefit from weight management advice please advise them to speak to their

family doctor (GP).

Following the Eatwell plate can help when trying to lose weight. This makes

healthy eating easier to understand by showing the types and amounts of foods

we need to have a healthy and well balanced diet.

Fruit and vegetables

Bread, rice, potatoes, pasta and other starchy foods

Meat, fish, eggs, beans and other non-dairy sources of protein

Foods and drinks high in fat and/or sugar

Milk and dairy foods

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The Eatwell plate shows how much of what we eat should come from each food group. This includes everything we eat during the day, including snacks.

So, we should try to eat: plenty of fruit and vegetables (at least five portions of a variety a day)

plenty of bread, rice, potatoes, pasta and other starchy foods – choose wholegrain varieties whenever you can

some milk and dairy foods

some meat, fish (eat two portions of fish a week, one of which should be oily - for example mackerel, sardines, trout and herring) eggs, beans and other non-dairy sources of protein.

just a small amount of foods and drinks high in fat and/or sugar

Look at the Eatwell plate to see how much of a whole day’s food should come from each food group and try to match this in the diet of the person you care for.

Try to choose options that are lower in fat, salt and sugar when you can.

For more information on eating a healthy diet, visit: www.eatwell.gov.uk

Active lifestyleHaving an active lifestyle is known to help when trying to lose weight.

It is recommended that adults get a minimum of 30 minutes of physical activity on at least five days per week and keep the amount of time spent sitting down to a minimum. You may want to encourage the person (if appropriate) to make small manageable steps to become more active for example getting off the bus one stop earlier and walking the rest of the journey.

A community learning disability nurse would be able to advise you on this.

For more information on living an active lifestyle visit www.activescotland.org.uk

A walking toolkit to promote activity and health reflux ...1].pdf · Gastro-oesophageal reflux...

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