User:Mansourceline/Gastroesophageal reflux disease

Adults
The most common symptoms of GERD in adults are an acidic taste in the mouth, regurgitation, and heartburn. Less common symptoms include pain with swallowing/sore throat, increased salivation (also known as water brash), nausea, chest pain, coughing, and globus sensation. The acid reflux can induce asthma attack symptoms like shortness of breath, cough, and wheezing in those with underlying asthma.

GERD sometimes causes injury to the esophagus. These injuries may include one or more of the following:


 * Reflux esophagitis – inflammation of esophageal epithelium which can cause ulcers near the junction of the stomach and esophagus
 * Esophageal strictures – the persistent narrowing of the esophagus caused by reflux-induced inflammation
 * Barrett's esophagus – intestinal metaplasia (changes of the epithelial cells from squamous to intestinal columnar epithelium) of the distal esophagus
 * Esophageal adenocarcinoma – a form of cancer

GERD sometimes causes injury of the larynx (LPR). Other complications can include aspiration pneumonia.

Differential diagnosis
Other causes of chest pain such as heart disease should be ruled out before making the diagnosis. Another kind of acid reflux, which causes respiratory and laryngeal signs and symptoms, is called laryngopharyngeal reflux (LPR) or "extraesophageal reflux disease" (EERD). Unlike GERD, LPR rarely produces heartburn, and is sometimes called silent reflux. Differential diagnosis of GERD can also include dyspepsia, peptic ulcer disease, esophageal and gastric cancer, and food allergies.

Lifestyle changes
Certain foods may promote GERD, but most dietary interventions have little effect. Some evidence suggests that reduced sugar intake and increased fiber intake can help. Avoidance of specific foods and not eating before lying down are recommended for those having GERD symptoms. Foods that may precipitate GERD include coffee, alcohol, chocolate, fatty foods, acidic foods, and spicy foods.

Weight loss may be effective in reducing the severity and frequency of symptoms. Elevating the head of the entire bed with blocks, or using a wedge pillow that elevates the individual's shoulders and head, may inhibit GERD when lying down. Although moderate exercise may improve symptoms in people with GERD, vigorous exercise may worsen them. Breathing exercises may relieve GERD symptoms.

Abstinence from smoking or alcohol does not appear to significantly relieve symptoms.

Pregnancy
GERD is a common condition that develops during pregnancy, but usually resolves after delivery. The severity of symptoms tend to increase throughout the pregnancy. In pregnancy, dietary modifications and lifestyle changes may be attempted, but often have little effect. Some lifestyle changes that can be implemented are elevating the head of the bed, eating small portions of food at regularly scheduled intervals, reduce fluid intake with a meal, avoid eating 3 hours before bedtime, and refrain from lying down after eating. Calcium-based antacids are recommended if these changes are not effective, aluminum- and magnesium hydroxide -based antacids are also safe. Antacids that contain sodium bicarbonate or magnesium trisilicate should be avoided in pregnancy. Sucralfate has been studied in pregnancy and proven to be safe as is ranitidine and PPIs.

Lead
Pregnancy:

- lifestyle changes are first line before adding medications (reference #19)

- elevating head of bed (Reference #19)

- GERD is a common condition that develops during pregnancy & usually resolves after delivery (Reference #17)

- severity of symptoms tend to increase throughout pregnancy (Reference #17)

- medication safety

- calcium, aluminum, magnesium bases antacids considered safe in pregnancy ( Reference #17)

- avoid use of antacids that contain magnesium trisilicate because can cause cardiovascular problems in fetus (Ref #17)

- avoid using sodium bicarb because can cause metabolic alkalosis(Reference #17),

- sucralfate also safe, can use if antacids do not provide relief to patient (Reference #17)

- cimetidine and ranitidine have both been used in pregnancy, studies have been done about use of ranitidine during pregnancy and outcomes showed that is was safe to use and also more effective than antacids. Cimetidine can have minor anti-androgenic effects, but no evidence that it has an effect on developing fetus (Ref #14)

Symptoms in adults (using this reference --> https://www-ncbi-nlm-nih-gov.uml.idm.oclc.org/pmc/articles/PMC6140167/ ):

- feeling of fullness or sensation of lump in the back of throat

- acid reflux can lead to bronchospasm in those with asthma --> can trigger asthma attack and cause symptoms like wheezing, SOB, cough

- non-cardiac chest pain

Differential Diagnosis (using this reference --> https://www-sciencedirect-com.uml.idm.oclc.org/science/article/pii/S0095454317300957?via%3Dihub)

- dyspepsia, peptic ulcer disease, esophageal and gastric cancer, food allergies

Possible sources to use:

1) https://journals-lww-com.uml.idm.oclc.org/gastroenterologynursing/Fulltext/2019/01000/Gastroesophageal_Reflux_Disease__Pathophysiology,.3.aspx

2) https://journals-lww-com.uml.idm.oclc.org/tnpj/Fulltext/2013/08000/Evidence_based_recommendations_for_GERD_treatment.7.aspx

3) https://www-sciencedirect-com.uml.idm.oclc.org/science/article/pii/S088985531630005X?via%3Dihub

4) https://www-ncbi-nlm-nih-gov.uml.idm.oclc.org/pmc/articles/PMC6140167/