GERD

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GERD

• Gastroesophageal Reflux Disease

By Ruth Fernandez Faviola Calixto Vanessa
Oyola
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What is GERD ?

• GERD is the return of the stomachs acidic
  contents back up to the esophagus

nchmedicalgroup.com
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Question 1

• How long is the esophagus?
• Answer The esophagus is an 18 to 26 cm hollow
  muscular tube that acts as a conduit for the
  transport of food from the oral cavity to the
  stomach.
• http//www.redorbit.com/news/health/274845/underst
  anding_acid_reflux_and_its_dental_manifestations/

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What causes GERD ?

• GERD is caused by a weak or relaxed lower
  esophageal sphincter, the junction between the
  esophagus and the stomach

Dallasreflux.com
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Question 2

• About how many Americans are affected with GERD?
• Answer Approximately 19 million Americans are
  affected with GERD.
• http//heartburn.about.com/od/gerdacidrefluxdiseas
  e/a/gerd_facts.htm

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Question 3

• Does GERD affect infants?
• Answer Yes, About 1 in 300 infants will present
  signs and symptoms of GERD.
• http//www.coliccalm.com/baby_infant_newborn_artic
  les/acid-reflux.htm

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Symptoms of GERD

• Heartburn
• Chest pain
• Coughing or choking while lying down
• Increased asthma symptoms while sleeping

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Question 4

• What is the percentage of Americans suffering
  from heartburn?
• Answer Evidence indicates that up to 36 (60
  million Americans) of the Americans suffer
  heartburn once a month and 7 (25 million
  Americans) suffer heartburn every day.
• http//heartburn.about.com/od/understandingheartbu
  rn/a/heartburn_facts.htm

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Treatment for GERD

• Lifestyle Changes

Dietary Changes

• For severe GERD, it is recommended elevating the
  head of the bed on 6-inch blocks or sleeping on a
  specially designed wedge to reduce heartburn by
  allowing gravity to minimize reflux of stomach
  contents into esophagus

• Avoid foods and beverages that can weaken the
  lower esophageal sphincter such as chocolate,
  peppermint, fatty foods, coffee and alcoholic
  beverages
• Eating meals 2-3 hours before bedtime may lessen
  reflux by allowing the acid in the stomach to
  empty partially

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Treatment for GERD

• Along with lifestyle and diet changes, physician
  may recommend over-the-counter or prescription
  medications such as

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Over The Counter Drugs

• There are 3 Pharmacologic categories
• Antacids
• Histamine-2 (H2) blockers
• Proton Pump Inhibitors (PPIs)

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Antacids

• Maalox
• Mylanta
• Rolaids
• Tums
• MOA neutralize stomach acid
• Adverse effects chalky taste, stomach cramps,
  constipation, headache.

Drugline.org
Drugline.org
Soap.com
Drug3k.com
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Histamine-2 Blockers
MOA works by decreasing the amount of acid the
stomach produces

• Axid AR (nizatidine)
• Pepcid AC (famotidine)
• Zantac 75 (ranitidine)
• Tagamet HB (cimetidine)
• Adverse effects headache, dizziness, diarrhea,
  constipation, abdominal pain, rash, fever.

Drugshoponline.com
Planterx.com
Vitacost.com
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Proton Pump Inhibitors

• MOA blocks acid production and heal the
  esophagus.
• Prevacid 24HR (Lansoprazole)
• Prilosec OTC (Omeprazole)
• Zegerid OTC (Omeprazole and
• Sodium Bicarbonate)
• Adverse effect headache, dizziness, rash,
  abdominal pain, constipation, diarrhea, nausea.

Amazon.com
Walmart.com
Drugcounter.com
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Prescription Medications

• There are 3 Pharmacologic Categories
• Histamine-2 (H2) Blockers
• Proton Pump Inhibitors
• Promotility Agents

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Histamine-2 (H2) Blockers

• Tagamet
• Zantac
• Pepcid
• MOA- works by decreasing the amount of acid the
  stomach produces.
• Adverse Affects- headache, abdominal pain,
  diarrhea, nausea, gas, sore throat, runny nose,
  and dizziness.

Drug3k.com
Drug3k.com
Everydayhealth.com
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Proton Pump Inhibitors

• Nexium
• Protonix
• Aciphex
• Prevacid
• MOA- blocks acid production and heals the
  esophagus.
• Adverse Affects- headache, diarrhea, abdominal
  pain, and nausea.

Rubell.com
Prescriptionpictures.com
Drugs.com
Totalhealth4life.net
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Promotility Agents

• Reglan
• MOA- help speed digestion, reducing the amount of
  time that acidic contents stay in the stomach.
  These may be used when therapy with H2 Blockers
  or PPIs do not work.
• Adverse Affects- drowsiness, fatigue, diarrhea,
  restlessness, and movement disorders (dyskinesia)

Pubrecord.org
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Another treatment for GERD

• When medications are not enough to treat and
  relieve the symptoms of GERD, surgery is another
  option.
• The most common surgery for GERD is called
  Fundoplication surgery.
• In this surgery the upper curve of the stomach
  (the fundus) is wrapped around the esophagus and
  sewn into place so that the lower portion of the
  esophagus passes through a small tunnel of
  stomach muscle. This surgery strengthens the
  valve between the esophagus and stomach (lower
  esophageal sphincter), which stops acid from
  backing up into the esophagus as easily. This
  allows the esophagus to heal.
• This surgery helps 60-90 of the people with
  GERD.

Dallasreflux.com
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Oral manifestations of GERD

• Enamel erosion
• Bruxism (tooth grinding or clenching)
• Oral mucosal lesions may result by direct acid or
  acidic vapor contact in the oral cavity such as
  oral ulcers, erythema of the palatal mucosa and
  uvula
• Xerostomia

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Role of Dental Hygienists

• Recommendations
• Smoking cessation. Smoking weakens the lower
  esophageal sphincter and increases reflux
• Do not brush immediately after reflux
• Patients should be advised to rinse their mouths
  either with water, milk sodium bicarbonate
  solutions or sodium fluoride mouth rinses
• Brushing teeth, chewing hard foods and sugar-
  free gums should be avoided for approximately 2
  hours after a regurgitation episode to allow for
  the re-establishment of salivary pellicle and
  subsequent tooth surface remineralization
• Nutritional counseling
• Use of specific oral products to keep oral cavity
  and dentition protected
• Discussing with health care provider the intake
  of certain medications such as over-the-counter
  pain relievers, including aspirin, ibuprofen
  (Advil, Motrin), or medicines for osteoporosis.
  These can aggravate reflux in some people