GERD
Gastroesophageal Reflux Disease
By:
Ruth Fernandez
Faviola Calixto
Vanessa Oyola
What is GERD ?
GERD is the return of the stomach’s
acidic contents back up to the
esophagus
nchmedicalgroup.com
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/understanding_acid_reflux_and_its_dental_manifestations/
What causes GERD ?
• GERD is caused by a
weak or relaxed lower
esophageal sphincter,
the junction between
the esophagus and the
stomach
Dallasreflux.com
Question #2
About how many Americans are affected with GERD?
Answer: Approximately 19 million Americans are affected with
GERD.
http://heartburn.about.com/od/gerdacidrefluxdisease/a/gerd_facts.htm
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_articles/acid-reflux.htm
Symptoms of GERD
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Heartburn
Chest pain
Coughing or choking while lying
down
Increased asthma symptoms while
sleeping
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/understandingheartburn/a/heartburn_facts.htm
Treatment for GERD
Lifestyle 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
Dietary Changes
• 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
Treatment for GERD
• Along with lifestyle and diet changes,
physician may recommend over-thecounter or prescription medications
such as:
Over The Counter Drugs
• There are 3 Pharmacologic categories:
1. Antacids
2. Histamine-2 (H2) blockers
3. Proton Pump Inhibitors (PPIs)
Antacids
•Maalox
•Mylanta
•Rolaids
Drugline.org
Drugline.org
•Tums
MOA: neutralize stomach acid
Drug3k.com
Soap.com
Adverse effects: chalky taste, stomach cramps, constipation,
headache.
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)
Drugshoponline.com
Planterx.com
Vitacost.com
Adverse effects: headache, dizziness, diarrhea,
constipation, abdominal pain, rash, fever.
Proton Pump Inhibitors
MOA: blocks acid production and heal the esophagus.
•Prevacid 24HR (Lansoprazole)
•Prilosec OTC (Omeprazole)
•Zegerid OTC (Omeprazole and
Sodium Bicarbonate)
Walmart.com
Amazon.com
Drugcounter.com
Adverse effect: headache, dizziness, rash, abdominal pain,
constipation, diarrhea, nausea.
Prescription Medications
• There are 3 Pharmacologic Categories:
1. Histamine-2 (H2) Blockers
2. Proton Pump Inhibitors
3. Promotility Agents
Histamine-2 (H2) Blockers
• Tagamet
• Zantac
• Pepcid
Drug3k.com
Drug3k.com
Everydayhealth.com
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.
Proton Pump Inhibitors
• Nexium
• Protonix
• Aciphex
• Prevacid
Prescriptionpictures.com
Rubell.com
Drugs.com
Totalhealth4life.net
MOA- blocks acid production and heals the esophagus.
Adverse Affects- headache, diarrhea, abdominal pain, and
nausea.
Promotility Agents
• Reglan
Pubrecord.org
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 PPI’s do not work.
Adverse Affects- drowsiness, fatigue, diarrhea, restlessness,
and movement disorders (dyskinesia)
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
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
Role of Dental Hygienists
• Recommendations:
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•
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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