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:
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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
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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:
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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: 98.6
Pulse: 90
BP: 119/75
Height: 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, 1632 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 Needs
Hamwi Method
106 lbs + 6(9)= 160 lbs IBW
160 lbs/2.2= 72.7 kg
IBW + 0.25 (usual- IBW)= 160 + 0.25 (215-160)= 173.75 lbs
173.75 lbs/2.2= 79.0 kg
Mifflin-St.Jeor
Actual Needs with Activity Factor
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 Requirement
Protein RDA: 0.8 g/kg/day
0.8 g x 97.7 kg= 78.2 g protein/day
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 F
40-160 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
Jack Nelson
❖ 48 year old male
Food/nutrition hx:
Biochemical
data/Medical
tests/procedures:
Anthropometric
data:
Physical exam findings:
Client hx:
Average intake: ~3600
kcal/day
Estimated needs:
~ 2600-2700 kcal/day
Has 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: 98.6
Pulse: 90
Resp rate: 16
BP: 119/75
Ht: 5’9”
Wt: 215 lbs
Mildly obese
Mild distress
BMI: 31.8 kg/m2
adjusted BW: 160 lbs
PA: little to no
exercise
Family history of
heart disease
Gained 35 lbs since
knee surgery
Stress increased in
past year
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 painfree, 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