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irrational or abnormal fear of eating
term for pain when swallowing. The pain may stem from the mouth, throat (pharynx) or esophagus (gullet)
evaluates relaxation of the LES and degree of coordination of esophageal contractions by measuring the amt of pressure generated by esophageal muscles
test to examine lining of esophagus, stomach, & duodenum via endoscope down throat
motility disorder of the esophagus in which the LES fails to relax properly & swallowing is disordered. also may have weakened or absence of peristalsis w/in esophagus
what is the underlying problem in ppl with achalasia?
not enough VIP & NO (vasoactive inhibitory peptide & nitric oxide) (inhibitory) and too much acetylcholine (excitatory)
S&S of achalasia (7)
- chest pain
- wt loss
- nutrient deficiencies
tests used to diagnose achalasia
- barium swallow
nutritional management of achalasia before medical therapy
- semisolid or liq food, as tol
- small, freq meals, as tol
- eat slowly
- avoid temp extremes
- avoid acidic & highly spiced foods
- lower fiber-may improve swallowing
- increase % kcals from fat (? evidence)
- protein & kcal dense foods
- TF may be indicated
treatments of achalasia (4)
- nitrates; calcium channel blockers: temp relief
- botox: blocks acetylcholine, so NO gets released slower & LES relaxes
- pneumatic dilation: mechanical dilation with a balloon-type thing
- surgery: laparoscopic esophageal myotomy (making incisions into the muscles in order to weaken them) & partial fundoplication
complications of treatments of achalasia
with dilation and surgery, reflux esophagitis can occur
occurs as a result of reflux of gastric contents into the esophagus
etiology of GERD
- factors that lower LES pressure & therefore cause LES incompetence:
- increased secretion of hormones gastrin, estrogen, progesterone
- presence of hiatal hernia, scleroderma, obesity
- cig smoking
- some meds
- some foods
S&S GERD (6)
- increased salivation
- nausea (uncommon)
how is GERD diagnosed?
symptoms + (5)
- esophagogram (barium swallow)
- endoscopy: to see if es. is damaged
- esophageal manometry: measures pressure & motility
- 24 hour esophageal pH monitoring: nasal tube to stomach, probe on end measures pH (BEST)
- gastric emptying: delayed can cause pressure & GERD
potential nutrition management strategies for GERD (4)
- 1. prevent reflux: less fat; avoid peppermint, spearmint, choc (which relax LES)
- 2. dec acidity of gastric secretions: avoid coffee, caffeine, alcohol, red & blk pepper
- 3. improve clearing of esophagus: fluid b/w meals, small & freq meals
- 4. reduce intra-abdominal pressure: inc fiber (to reduce constipation), wt reduction
how to manage GERD when esophageal lesions are present? (2)
- avoid foods w/acidic pH
- avoid irritating spices: chili powder; blk & red pepper
behavioral changes for GERD- avoid: (5)
- lying down after meals
- tight fitting clothing; obesity
- eating w/in 3-4 hrs of bedtime
- elevate head of bed
general types of meds to manage GERD (5)
- histamine-2 receptor blockers
- proton pump inhibitors
- prokinetic/LES pressure changing agent
- protective barrier (foaming) agent
What category of GERD meds?
histamine-2 receptor blockers
how do histamine-2 receptor blockers work?
- less acid gets produced
- normally, vagal stimulation from stress, eating, smelling food, etc stimulates production of histamine, which binds to HCL receptor in stomach, stimulating HCL production; but blocker stops histamine from binding, therefore no HCL made
how do proton pump inhibitors work?
acid can't be pumped into the stomach
Category of GERD med?
omeprazole + NaHCO3 (Zegerid)
proton pump inhibitors
Category of GERD med?
prokinetic/LES pressure changing agent
how do prokinetic/LES pressure changing agents help GERD?
LES gets tighter
Category of GERD med?
protective barrier (foaming) agent
how do protective barrier (foaming) agents help improve GERD?
foam lays on top of gastric contents so no HCL splashes up
what type of surgical treatment can be done for GERD? & what is done during the procedure?
- an incision is made through either the abdomen or chest in order to wrap the upper curve of the stomach around the esophagus. The stomach is then stitched in place to help support the valve, and help it to work, as it should. This surgery is meant to strengthen the esophageal sphincter.