GERD

By: Kaitlyn Click and Meghan Chokreff

Background on GERD❖ Stomach contents leak backwards from the stomach into the esophagus.

Reflux occurs if the muscular actions in the esophagus or other protective mechanisms fail, such as LES.

❖ Some complications include: ➢ Impaired swallowing, aspiration of gastric contents, ulcerations,

perforation or stricture of the esophagus, and Barrett’s Esophagus❖ Some signs and symptoms include:

➢ Dysphagia, heartburn, increases salvation, belching, pain throughout the body

Patient Demographics

Jack Nelson: ❖ 48 years old ❖ Male❖ Caucasian ❖ Married--lives with his wife, Mary, and their 2 sons❖ Works M-F, on evenings and weekends as well❖ Protestant❖ BA

Patient History❖ Onset:

➢ Experiencing increased indigestion over the past year➢ Used to be only at night but now it is more consistent throughout the day

❖ Medical: ➢ Essential HTN since a year ago

❖ Surgical:

➢ s/p Right knee arthroplasty 5 years ago

➢ gained almost 35 lbs since knee surgery❖ Medications:

➢ Atenolol 50 mg daily; 325 mg aspirin daily; multivitamin daily; 500 mg ibuprofen 2x daily for the last month❖ Family history:

➢ Father: CAD❖ Nutrition/dietary:

➢ Eating and drinking more over the past year due to stress: 1-2 beers 3-4 times a week➢ Does not exercise regularly: playing with his children is his only exercise➢ Does not follow any dietary restrictions; no previous nutrition therapy➢ No tobacco use➢ Fried foods make indigestion worse➢ Wife purchases food or they eat out

Vitals

Temp: 98.6Pulse: 90BP: 119/75Height: 5’9” Weight: 215 lbs (mildly obese)

Nutrition Usual Dietary Intake: ❖ AM: 1 ½-2 c dry cereal (Cheerios, bran flakes, Crispix), ½-¾ c skim milk, 16-

32 oz orange juice❖ Lunch: 1 ½ oz ham on ww bagel, 1 apple or other fruit, 1 c chips, diet soda❖ Snack when he comes home: Handful of crackers, cookies, or chips, 1-2 16

oz beers❖ PM: 6-9 oz meat (grilled, baked usually), pasta, rice, or potatoes, 1-2 c fresh

fruit, salad or other vegetable, bread, iced tea❖ Late PM: Ice cream, popcorn, or crackers. Drinks 5-6 12 oz diet sodas daily as

well as iced tea. Relates that his family’s schedule has been increasingly busy, so they order pizza or stop for fast food 1-2 times per week instead of cooking

24-Hour Recall

Breakfast Crispix--2c, 1 c skim milk, 16 oz orange juice

At work snack 3 12-oz Diet Pepsis

Lunch Fried chicken sandwich from McDonald’s, small French fries, 32 oz iced tea

Late afternoon snack 2 c. chips, 1 beer

Dinner 1 breast, fried, from KFC, 1 ½ c potato salad, ¼ c green bean casserole, ½ c fruit salad, 1 c baked beans, iced tea

Bedtime snack 2 c ice cream mixed with 1 c skim milk for milkshake

Total kcal: ~3600 kcal

Estimated Needs106 lbs + 6(9)= 160 lbs IBW160 lbs/2.2= 72.7 kg IBW + 0.25 (usual- IBW)= 160 + 0.25 (215-160)= 173.75 lbs173.75 lbs/2.2= 79.0 kg REE= 10 x wt(kg) + 6.25 x ht(cm) – 5 x age (yrs) + 5 = 10 x 79 kg + 6.25 x 175.3 cm – 5 x 48 + 5 = 790 + 1095.6 – 240 + 5 = 1650.6 kcal TEE= REE x activity factor

1650.6 x 1.6=2641 kcal

~2600-2700 kcal needed to maintain weight Protein RDA: 0.8 g/kg/day 0.8 g x 97.7 kg= 78.2 g protein/day

Hamwi Method

Mifflin-St.Jeor

Actual Needs with Activity Factor

Protein Requirement

Abnormal Labs

Chemistry Reference Range 9/22

Cholesterol (mg/dL) 120-199 220

HDL-C (mg/dL) >55 F, >45 M 20

LDL (mg/dL) <130 165

LDL/HDL ratio <3.22 F<3.55 M

8.25

Triglycerides (mg/dL) 35-135 F40-160 M

178

Foods to Steer Clear From… Bad Food Choices

Caffeine/Tea

Chocolate

Chips

Fried Foods

Foods High in Fat

Carbonated beverages

High Fat milk products

Alcohol

Medication

❖ Take Omeprazole in the AM because it is a proton pump inhibitor, which means it will block H+, K+-ATPase enzymes

❖ Decrease aspirin to 75 mg and stop taking ibuprofen because these medications have an effect on the stomach and will decrease the lining in the stomach causing GERD.

Nutrition Assessment

Food/nutrition hx: Biochemical data/Medical tests/procedures:

Anthropometric data:

Physical exam findings: Client hx:

Average intake: ~3600 kcal/dayEstimated needs: ~ 2600-2700 kcal/dayHas not followed any diet restrictions Meds: Atenolol 50 mg, aspirin 325 mg, multivitamin, ibuprofen 500 mg 2x/day

s/p R knee arthroplasty 5 years ago Labs: Chol 220 mg/dL, HDL 20 mg/dL, LDL 165 mg/dL, TG 178 mg/dL

Temp: 98.6Pulse: 90Resp rate: 16BP: 119/75Ht: 5’9”Wt: 215 lbs

Mildly obeseMild distressBMI: 31.8 kg/m2adjusted BW: 160 lbs

PA: little to no exercise Family history of heart diseaseGained 35 lbs since knee surgeryStress increased in past year

Jack Nelson❖ 48 year old male

Nutrition Diagnosis

PES #1: Excessive energy intake (NI-1.3) related to being mildly obese as evidenced by patient’s 24-hour recall, weight of 215 pounds, and BMI of 31.8.

PES #2: Physical inactivity (NB-2.1) related to a sedentary lifestyle as evidenced by self-report of only activity is playing with children on the weekends.

Nutrition Intervention Diet/Nutrition: Instruct client on 3000 kcal diet for 3 months and then 2600 kcal diet for 3 more months. Educate Mr. Nelson and his wife about healthy meal options, portion sizes, methods of cooking, and benefits of eating at home. Provide client with a “Foods to Avoid” list that will help alleviate symptoms of GERD.

Physical activity: Introduce client to physical activities that are easy on his knee, such as swimming, and parking a little further away from the entrance at work. We will also refer Mr. Nelson to a physical therapist to help him with knee discomfort. Once he is pain-free, we can implement a “step-plan” of 3,000 steps/day, increasing by 500 steps/week.

Nutrition Monitoring/Evaluation

Monitor patient compliance with intervention: ★ Food journal--kcal, fat, sodium, total saturated fat★ Physical activity journal ★ Cholesterol, HDL, LDL, TG, BMI, BP

Compare this data to his initial visit. Have client email logs to dietitian before meetings and call about their progress on a weekly basis.

Questions

1. What does GERD stand for? 2. What are the complications of GERD?3. What are some signs and symptoms of GERD?4. What is one controllable risk factor?

References Academy of Nutrition and Dietetics (2014). Pocket guide for international dietetics & nutrition

terminology (IDNT) reference manual: Standardized language for the nutrition care process. Chicago, Ill: Academy of Nutrition and Dietetics.

Gastroesophageal Reflux Disease (GERD). (2011). Retrieved September 8, 2014, from

http://www.lef.org/protocols/gastrointestinal/gastroesophageal_reflux_06.htm

George F. Longstreth. Medline Plus. (2012). Esophageal pH Monitoring. Rockville Pike,

Bethesda, MD.

Nahikian-Nelms, M., & Roth, S. L. (2013). Medical nutrition therapy: A case study approach. Stamford, Connecticut: Cengage Learning.

Nelms, M. N., Sucher, K., Lacey, K., & Roth, S. L. (2011). Nutrition therapy and pathophysiology (2nd ed.). Belmont, CA: Brooks/Cole Cengage Learning

Understanding Upper Endoscopy. (n.d.). Retrieved September 8, 2014, from

http://www.asge.org/patients/patients.aspx?id=378