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Evaluation\tof\tthe\tbasophil\tactivation\ttest\tand\n\tskin\tprick\ntesting\tfor\tthe\tdiagnosis\tof\tfood\tallergy\n\tClin\tExp\tAllergy\t8,\t2018;48:\t1025-1034.\nAsai\tY,\tEslami\tA,\tvan\tGinkel\tCD.\tet\tal.\t\nGenome-wide\tassociation\tstudy\tand\tmeta-analysis\tin\tmultiple\npopulations\tidentifies\tnew\tloci\tfor\tpeanut\tallergy\tand\testablishes\tC11orf30/EMSY\tas\ta\tgenetic\trisk
|
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factor\tfor\tfood\tallergy\n\tJ\tAllergy\tClin\tImmunol\t2018;141:\t991-1001.\nAsaumi\tT,\tEbisawa\tM.\t\nHow\tto\tmanage\n\tfood\tdependent\texercise\tinduced\tanaphylaxis\t(FDEIA)\n\tCurr\nOpinion\tin\tAllergy\tClin\tImmunol\t2018;18:\t243-247.
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] |
26\nMedical\tnutrition\ttherapy\tfor\nupper\tgastrointestinal\ttract\ndisorders\nDeeAnna\tWales\tVanReken,\tMS,\tRDN,\tCD,\tIFNCP\nKEY\tTERMS\nachalasia\nachlorhydria\nachylia\tgastrica\nacid\tpocket\natrophic\tgastritis\nBarrett’s\tesophagus\t(BE)\nbezoar\nBillroth\tI\t(gastroduodenostomy)\nBillroth\tII\t(gastrojejunostomy)\ncannabinoid\thyperemesis\tsyndrome\ndumping\tsyndrome
|
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] |
cannabinoid\thyperemesis\tsyndrome\ndumping\tsyndrome\nduodenal\tulcer\ndyspepsia\ndysphagia\nendoscopy\nesophagectomy\nesophagitis\nesophagogastroduodenoscopy\t(EGD)\nfunctional\tdyspepsia\ngastrectomy\ngastric\tpull-up\ngastric\tulcer\ngastritis\ngastroesophageal\treflux\t(GER)\ngastroesophageal\treflux\tdisease\t(GERD)\ngastroparesis\nheartburn\nHelicobacter\tpylori
|
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gastroparesis\nheartburn\nHelicobacter\tpylori\nhematemesis\nhiatal\thernia\nlower\tesophageal\tsphincter\t(LES)\nmelena\nmucosa-associated\tlymphoid\ttissue\t(MALT)\nNissen\n\tfundoplication\nodynophagia\nparietal\tcells\nparietal\tcell\tvagotomy\npeptic\tulcer\tdisease
|
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] |
pyloroplasty\nRome\tIV\tcriteria\nRoux-en-Y\nscintigraphy\nstress\tulcer\nupper\tesophageal\tsphincter\t(UES)\nvagotomy\nvagotomy,\ttruncal\nvagus\tnerve\nThe\tupper\tgastrointestinal\ttract\tis\tthe\tportion\tof\tthe\talimentary\tcanal\tcontaining\tthe\tesophagus,\nstomach,\tand\tduodenum.\tAlong\twith\tthose\tsegments,\tthe\toral\n\tcavity\twill\talso\tbe\tincluded\tas\trelevant
|
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] |
cavity\twill\talso\tbe\tincluded\tas\trelevant\nin\tthis\tchapter.\nDigestive\tdisorders\tof\tboth\tthe\tupper\tand\tlower\tgastrointestinal\t(GI)\ttract,\tare\tamong\tthe\tmost\ncommon\tproblems\tin\thealth\tcare\t(see\t\nChapter\t27\n).\tBetween\t60\tand\t70\tmillion\tpeople\tare\taffected\tby
|
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] |
Chapter\t27\n).\tBetween\t60\tand\t70\tmillion\tpeople\tare\taffected\tby\nall\tdigestive\tdiseases,\twith\tover\t48\tmillion\tambulatory\tcare\tvisits\tmade\tannually\tin\tthe\tUnited\tStates\nalone\t(\nNational\tInstitutes\tof\tHealth\t[NIH],\t2014\n).\tAs\tdigestive\tdisorders\tare\tthe\tleading\tcause\tof\tall
|
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performed\teach\tyear\t(\nCDC,\t2015\n).\tDietary\thabits\tand\tspecific\tfoods\n\tcan\tplay\tan\timportant\trole\tin\tthe\nonset,\ttreatment,\tand\tprevention\tof\tmany\tGI\tdisorders.\tMedical\tnutrition\ttherapy\tis\tintegral\tin\tthe\nprevention\tand\ttreatment\tof\tmalnutrition\tand\tdeficiencies\tthat\tcan\tdevelop\tfrom\ta\tGI\ttract\tdisorder.
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] |
Diet\tand\tlifestyle\tmodifications\tcan\timprove\ta\tpatient’s\tquality\tof\tlife\tby\talleviating\tGI\tsymptoms\tand\ndecreasing\tthe\tnumber\tof\thealth\tcare\tvisits\tand\tcosts\tassociated\n\twith\tGI\tdisease.\nThe\tesophagus\nThe\tesophagus\tis\ta\tmuscular\ttube\twith\tan\taverage\tlength\tof\t25\tcm\tin\tadults\t(\nFig.\t26.1\n),\twith\tthe
|
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] |
Fig.\t26.1\n),\twith\tthe\nsingle\tbut\timportant\tfunction\tof\tdelivering\tsolids\tand\tliquids\tfrom\tthe\tmouth\tto\tthe\tstomach.\tIt\tis\nlined\twith\tnonkeratinized\tstratified\tsquamous\tepithelium,\tand\tsubmucosal\tglands\tsecrete\tmucin,\nbicarbonate,\tepidermal\tgrowth\tfactor,\tand\tprostaglandin\tE\n2\n,\twhich\tprotect\n\tthe\tmucosa\tfrom\tgastric\nacid.\nFIG.\t26.1
|
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] |
2\n,\twhich\tprotect\n\tthe\tmucosa\tfrom\tgastric\nacid.\nFIG.\t26.1\nNormal\tesophagus.\n\t\nSource:\n\t(Cleveland\tClinic,\tCleveland,\tOhio.)\nThe\ttop\tof\tthe\tesophagus\tis\tconnected\tto\tthe\tpharynx,\tand\tthe\tbottom\tof\tthe\tesophagus\tis\nconnected\tto\tthe\tstomach\tat\tthe\tcardia.\tIt\tis\thighly\tmuscular,\twith\tmuscles\tarranged\tin\ta\tway\tto
|
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] |
facilitate\tthe\tpassage\tof\tfood.\tAs\ta\tbolus\tof\tfood\tis\tmoved\tvoluntarily\tfrom\tthe\tmouth\tto\tthe\tpharynx,\nthe\t\nupper\tesophageal\tsphincter\t(UES)\n\trelaxes,\tthe\tfood\tmoves\tinto\tthe\tesophagus,\tand\tperistaltic\nwaves\tmove\tthe\tbolus\tdown\tthe\tesophagus;\tthe\t\nlower\tesophageal\tsphincter\t(LES)\n\trelaxes\tto
|
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] |
lower\tesophageal\tsphincter\t(LES)\n\trelaxes\tto\nallow\tthe\tfood\tbolus\tto\tpass\tinto\tthe\tstomach.\tThe\tesophageal\ttransit\ttime\ttakes\tan\taverage\tof\t5\nseconds\twhen\tin\tan\tupright\tposition,\tand\tup\tto\t30\tseconds\twhen\tin\ta\tsupine\tposition\t(\nla\tRoca-\nChiapas\tand\tCordova-Fraga,\t2011\n).\nThe\tnormal\tesophagus\thas
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la\tRoca-\nChiapas\tand\tCordova-Fraga,\t2011\n).\nThe\tnormal\tesophagus\thas\n\ta\tmultitiered\tdefense\tsystem\tthat\tprevents\ttissue\tdamage\tfrom
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0.08335720747709274,
0.11453435570001602,
0.057447031140327454,
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] |
exposure\tto\tgastric\tcontents,\tincluding\tLES\tcontraction,\tnormal\tgastric\tmotility,\tesophageal\tmucus,\ntight\tcellular\tjunctions,\tand\tcellular\tpH\tregulators.\tMusculoskeletal\tdisorders\tand\tmotility\tdisorders\nmay\tresult\tin\tdysphagia.\tFor\texample,\t\nachalasia\n\tis\tcharacterized\tby\ta\tfailure\tof\tesophageal\tneurons,\nresulting\tin\ta\tloss\tof\tability
|
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] |
resulting\tin\ta\tloss\tof\tability\n\tto\trelax\tthe\tLES\tand\thave\tnormal\tperistalsis.\nGastroesophageal\treflux\tdisease\t(GERD)\tand\tesophagitis\nEtiology\nGastroesophageal\treflux\t(GER)\n\tis\tconsidered\ta\tnormal\tphysiologic\tprocess\tthat\toccurs\tseveral\ntimes\ta\tday\tin\thealthy\tinfants,\tchildren,\tand\tadults.\tGER\tgenerally\tis\tassociated\twith\ttransient
|
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] |
relaxation\tof\tthe\tLES\tindependent\tof\tswallowing,\twhich\tpermits\tgastric\tcontents\tto\tenter\tthe\nesophagus.\tLimited\tinformation\tis\tknown\tabout\tthe\tnormal\tphysiology\tof\tGER\tin\tinfants,\tbut\nregurgitation\tand\tspitting\tup,\tas\tthe\tmost\tvisible\tsymptom,\tis\treported\tto\toccur\tdaily\tin\t50%\tof\tall\ninfants\t(\nLightdale\tand\tGremse,\t2013\n).
|
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] |
infants\t(\nLightdale\tand\tGremse,\t2013\n).\nGastroesophageal\treflux\tdisease\t(GERD)\n\tis\ta\tmore\tserious,\tchronic\tform\tof\tGER,\twith\nsymptoms\tor\tcomplications\tresulting\tfrom\tthe\treflux\tof\tgastric\tcontents\tinto\tthe\n\tesophagus\tor\nbeyond,\tand\teven\tinto\tthe\toral\tcavity\t(including\tlarynx)\tor\tlung.\tSymptoms\tare\tdefined\tto\tinclude\nheartburn
|
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] |
heartburn\n\t(painful,\tburning\tsensation\tthat\tradiates\tup\tbehind\tthe\tsternum\tof\tfairly\tshort\tduration)\nand/or\tregurgitation,\tat\tleast\tonce\ta\tweek.\tPrevalence\tis\tworldwide,\tmay\tbe\tincreasing\tover\ttime,\nand\tvaries\tby\tgeographic\tlocation.\tThe\tfollowing\tprevalence\testimates\twere\tpublished\tin\n\ta\t2014
|
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] |
a\t2014\nreview\tof\texisting\tepidemiologic\tstudies:\tNorth\tAmerica\t18%\tto\t28%;\tEurope\t9%\tto\t26%;\tMiddle\nEast\t9%\tto\t33%;\tAustralia\t12%;\tEast\tAsia\t3%\tto\t8%\t(\nEl-Serag\tet\tal,\t2014\n).\nEsophagogastroduodenoscopy\t(EGD)\n\tuses\ta\tfiberoptic\tendoscope\tto\tdirectly\tvisualize\tand\nexamine\tthe\tesophagus,\tstomach,\tand\tduodenum\tto\tclassify\tseverity\tof\tdisease\t(see
|
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] |
Focus\tOn:\nEndoscopy\tand\tCapsules\n).\tGERD\tcan\tbe\tclassified\n\tas\tnonerosive\tdisease\t(NERD),\tindicating\tthe\npresence\tof\tsymptoms\twithout\tabnormalities\tor\terosions,\tor\terosive\tdisease\t(ERD),\twith\tsymptoms\nand\terosions\tpresent.\tERD\tgenerally\tis\tassociated\twith\tmore\tsevere\tand\tprolonged\tsymptoms\ncompared\twith\tNERD\t(\nKatz\tet\tal,\t2013\n).
|
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] |
compared\twith\tNERD\t(\nKatz\tet\tal,\t2013\n).\nSome\tpatients\texperience\tGERD\tsymptoms\tprimarily\tin\tthe\tevening\t(nocturnal\tGERD),\twhich\thas\ta\ngreater\timpact\ton\tquality\tof\tlife\n\tcompared\twith\tdaytime\tsymptoms.\tNocturnal\tGERD\tis\tassociated\nsignificantly\twith\tsevere\t\nesophagitis\n\t(inflammation\tof\tthe\tesophagus)\tand\tBarrett’s\tesophagus\t(an
|
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] |
(inflammation\tof\tthe\tesophagus)\tand\tBarrett’s\tesophagus\t(an\nintestinal\tmetaplasia\tdescribed\tin\tfurther\tdetail\tlater\tin\tthis\tchapter)\tand\tcan\tlead\tto\tsleep\ndisturbance.\tPatients\twith\tERD\tare\tmore\tlikely\tto\tbe\tmen,\tand\twomen\tare\tmore\tlikely\tto\thave\tNERD.\nThere\tis\ta\tdefinite\trelationship\tbetween\tGERD\n\tand\tobesity.\tSeveral\tmeta-analyses\tsuggest\tan
|
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] |
and\tobesity.\tSeveral\tmeta-analyses\tsuggest\tan\nassociation\tbetween\tbody\tmass\tindex\t(BMI),\twaist\tcircumference,\tweight\tgain,\tand\tthe\tpresence\tof\nsymptoms\tand\tcomplications\tof\tGERD.\tGERD\tis\tfrequent\tduring\tpregnancy,\tusually\tmanifesting\tas\nheartburn,\tand\tmay\tbegin\tin\tany\ttrimester.\tSignificant\tpredictors\tof\theartburn\tduring\tpregnancy\tare
|
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] |
increasing\tgestational\tage,\theartburn\tbefore\tpregnancy,\tand\tparity\n\t(\nKatz\tet\tal,\t2013\n)\t(see\t\nChapter\n14\n).\tOne\tKorean\tstudy\talso\tfound\ta\tsignificant\tassociation\tbetween\tdegree\tof\tpsychosocial\tstress\tand\nreflux\tesophagitis\tseverity\t(\nSong\tet\tal,\t2013\n).\nChest\tpain\tmay\tbe\ta\tsymptom\tof\tGERD,\tand\tdistinguishing\tcardiac\tfrom\tnoncardiac\tchest\tpain\tis
|
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] |
required\tbefore\tconsidering\tGERD\tas\ta\tcause\tof\tchest\tpain.\tAlthough\tthe\tsymptoms\tof\tdysphagia\tcan\nbe\tassociated\twith\tuncomplicated\n\tGERD,\tits\tpresence\twarrants\tinvestigation\tfor\ta\tpotential\ncomplication,\tincluding\tan\tunderlying\tmotility\tdisorder,\tstricture,\tor\tmalignancy.\tPatients\twith
|
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] |
disruptive\tGERD\t(daily\tor\tmore\tthan\tweekly\tsymptoms)\thave\tan\tincrease\tin\ttime\toff\twork\tand\ndecrease\tin\twork\tproductivity,\tand\ta\tdecrease\tin\tphysical\tfunctioning\t(\nKatz\tet\tal,\t2013\n).\nPathophysiology\nThe\tpathophysiology\tof\tGERD\tis\tcomplex.\t\nBox\t26.1\n\tdescribes\tpossible\tmechanisms\tinvolved\tin
|
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] |
Box\t26.1\n\tdescribes\tpossible\tmechanisms\tinvolved\tin\nGERD.\tThree\tcomponents\tmake\tup\tthe\tesophagogastric\tjunction:\tthe\tLES,\tthe\tcrural\tdiaphragm,\tand\nthe\tanatomic\tflap\tvalve.\tThis\tjunction\tacts\tas\tan\tantireflux\tbarrier.\tThe\tLES\tis\ta\t3-\tto\t4-cm\tsegment\nof\tcircular\tsmooth\tmuscle\tat\tthe\tdistal\tend\tof\tthe\tesophagus.\tThe\tresting\ttone\tof\tthis\tmuscle\tcan
|
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] |
vary\tamong\thealthy\tindividuals,\tranging\tfrom\t10\tmm\tHg\n\tto\t35\tmm\tHg\trelative\tto\tthe\tintragastric\npressure.\tThe\tmost\tcommon\tmechanism\tfor\treflux\tis\ttransient\tLES\trelaxations,\twhich\tare\ttriggered\nby\tgastric\tdistention\tand\tserve\tto\tenable\tgas\tventing\tfrom\tthe\tstomach.\tOn\taverage,\ttransient\tLES
|
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] |
relaxations\tpersist\tfor\tabout\t20\tseconds,\twhich\tis\tsignificantly\tlonger\tthan\tthe\ttypical\tswallow-\ninduced\trelaxation\t(\nBredenoord\tet\tal,\t2013\n).
|
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0.07513592392206192,
0.036892130970954895,
0.0016457322053611279
] |
BOX\t26.1\nPossible\tMechanisms\tInvolved\tin\tGastroesophageal\tReflux\nDisease\t(GERD)\n•\t\nDecreased\tsalivation\n•\t\nTransient\tlower\tesophageal\tsphincter\t(LES)\trelaxation\n•\t\nReduced\tLES\tpressure\n•\t\nImpaired\tesophageal\tacid\tclearance\n•\t\nIncreased\tesophageal\tsensitivity\n•\t\nAcid\tpocket\n•\t\nIncreased\tintraabdominal\tpressure\n•\t\nDelayed\tgastric\temptying
|
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] |
•\t\nIncreased\tintraabdominal\tpressure\n•\t\nDelayed\tgastric\temptying\nData\tfrom\tBeaumont\tH\tet\tal:\tThe\tposition\tof\n\tthe\tacid\tpocket\tas\ta\tmajor\trisk\tfactor\tfor\tacidic\treflux\tin\nhealthy\tsubjects\tand\tpatients\twith\tGORD,\t\nGut\n\t59:441,\t2010;\tBredenoord\tAJ\tet\tal:\tGastroesophageal\treflux\ndisease,\t\nLancet
|
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] |
disease,\t\nLancet\n\t381:1933,\t2013;\tPenagini\tR,\tBravi\tI:\tThe\trole\tof\tdelayed\tgastric\temptying\tand\timpaired\nesophageal\tmotility,\t\nBest\tPract\tRes\tClin\tGastroenterol\n\t24:831,\t2010.\nFor\treflux\tto\ttake\tplace,\tpressure\tin\tthe\tproximal\tstomach\n\tmust\tbe\tgreater\tthan\tthe\tpressure\tin\tthe
|
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] |
must\tbe\tgreater\tthan\tthe\tpressure\tin\tthe\nesophagus.\tPatients\twith\tchronic\trespiratory\tdisorders,\tsuch\tas\tchronic\tobstructive\tpulmonary\ndisease\t(COPD),\tare\tat\trisk\tfor\tGERD\tbecause\tof\tfrequent\tincreases\tin\tintraabdominal\tpressure.\tA\nchronically\tincreased\tpressure\talso\tis\tseen\tduring\tpregnancy\tand\tin\toverweight\tand\tobese\tpeople.
|
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] |
Hypersensitivity\tto\tacid\tcan\toccur\tin\tpeople\twith\terosive\tesophagitis\n\tand\tin\tthose\twith\tnormal\nmucosa.\tA\tfactor\tcontributing\tto\tincreased\tesophageal\tsensitivity\tto\tacid\tis\timpaired\tmucosal\tbarrier\nfunction.\tIn\ta\tsystematic\treview,\tthe\toverall\trate\tof\tgastric\temptying\twas\tdelayed\tin\tpatients\twith\nGERD\t(\nPenagini\tand\tBravi,\t2010
|
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] |
GERD\t(\nPenagini\tand\tBravi,\t2010\n).\tHowever,\ta\trelationship\tbetween\tdelayed\tgastric\temptying\tand\nincreased\treflux\tcould\tnot\tbe\tseen\tin\tthis\tstudy,\tsuggesting\tthat\timpaired\n\temptying\tof\tthe\tstomach\nas\ta\twhole\tis\tnot\tan\timportant\tdeterminant\tof\tGER.\nGood\tperistaltic\tfunction\tis\tan\timportant\tdefense\tmechanism\tagainst\tGERD,\tas\tprolonged\tacid
|
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] |
clearance\tcorrelates\twith\tthe\tseverity\tof\tesophagitis\tand\tthe\tpresence\tof\tcomplications\tsuch\tas\nBarrett’s\tesophagus.\tAn\toccurrence\tduring\tthe\tpostprandial\tperiod\tknown\tas\t\nacid\tpocket\n\tis\ta\tlayer\nof\tunbuffered,\thighly\tacidic\tgastric\n\tjuice\tat\tthe\tesophagogastric\tjunction,\tready\tto\treflux\tdue\tto\tthe
|
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juice\tat\tthe\tesophagogastric\tjunction,\tready\tto\treflux\tdue\tto\tthe\nabsence\tof\tperistaltic\tcontraction\tin\tthe\tproximal\tstomach.\nProlonged\tacid\texposure\tcan\tresult\tin\tesophagitis,\tesophageal\terosions,\tulceration,\tscarring,
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] |
stricture,\tand\tin\tsome\tcases\tdysphagia\t(see\t\nPathophysiology\tand\tCare\tManagement\tAlgorithm:\nEsophagitis\n).\tAcute\tesophagitis\tmay\tbe\tcaused\tby\treflux,\tingestion\tof\ta\tcorrosive\tagent,\n\tviral\tor\nbacterial\tinfection,\tintubation,\tradiation,\tor\teosinophilic\tinfiltration.\tEosinophilic\tesophagitis\t(EoE)\tis
|
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] |
characterized\tby\tan\tisolated,\tsevere\teosinophilic\tinfiltration\tof\tthe\tesophagus\tmanifested\tby\tGERD-\nlike\tsymptoms\tthat\tmay\tbe\tcaused\tby\tan\timmune\tresponse\t(see\t\nChapter\t25\n).\nThe\tseverity\tof\tthe\tesophagitis\tresulting\tfrom\tthe\tGER\tis\tinfluenced\tby\tthe\tcomposition,\tfrequency,\nand\tvolume
|
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0.0013845348730683327,
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0.023060863837599754,
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0.01662052981555462,
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0.031264595687389374,
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0.07454780489206314,
0.07481248676776886,
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0.029831133782863617,
0.0061063640750944614,
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0.09597119688987732,
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0.02778039313852787,
0.09222463518381119,
0.040514323860406876,
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0.007560110185295343,
0.08710888028144836,
0.07674109935760498,
0.07274466007947922,
-0.017311666160821915
] |
and\tvolume\n\tof\tthe\tgastric\treflux;\tthe\thealth\tof\tthe\tmucosal\tbarrier;\tlength\tof\texposure\tof\tthe\nesophagus\tto\tthe\tgastric\treflux;\tand\tthe\trate\tof\tgastric\temptying.\tSymptoms\tof\tesophagitis\tand\nGERD\tmay\timpair\tthe\tability\tto\tconsume\tan\tadequate\tdiet\tand\tinterfere\twith\tsleep,\twork,\tsocial\nevents,\tand\tthe\toverall\tquality\tof\tlife\t(\nTable\t26.1\n).
|
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0.06714016199111938,
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0.008852201513946056,
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0.08219654858112335,
0.05091346427798271,
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0.06566192209720612,
0.021692713722586632,
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0.09590496122837067,
0.009312690235674381,
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0.021023739129304886,
0.05643685534596443,
0.023355890065431595,
0.0001583985867910087,
0.02891954593360424,
0.06439560651779175,
0.07316814363002777,
0.0746021643280983,
-0.014465007930994034
] |
events,\tand\tthe\toverall\tquality\tof\tlife\t(\nTable\t26.1\n).\nTABLE\t26.1\nClinical\tSymptoms\tAssociated\twith\tGastroesophageal\tReflux\n\tDisease\t(GERD)\nDental\tcorrosion\nSlow,\tprogressive\ttooth\tsurface\tloss\tassociated\twith\tacid\tregurgitation\nDysphagia\nDifficulty\tinitiating\ta\tswallow\t(oropharyngeal\tdysphagia)\tor\tsensation\tof\tfood\tbeing
|
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] |
hindered\tor\t“sticks”\tafter\tswallowed\t(esophageal\tdysphagia)\nHeartburn\t(pyrosis)\nPainful,\tburning\tsensation\tthat\tradiates\tup\tbehind\tthe\tsternum\tof\tfairly\tshort\tduration\nOdynophagia\nPainful\n\tswallowing\nRegurgitation\nBackflow\tof\tgastric\tcontent\tinto\tthe\tmouth\tnot\tassociated\twith\tnausea\tor\tretching\nNoncardiac\tchest\npain
|
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] |
Noncardiac\tchest\npain\nUnexplained\tsubsternal\tchest\tpain\tresembling\ta\tmyocardial\tinfarction\twithout\nevidence\tof\tcoronary\tartery\tdisease\nExtraesophageal\nsymptoms\nChronic\tcough,\thoarseness,\treflux-induced\tlaryngitis,\tor\tasthma\nData\tfrom\tBredenoord\tAJ\tet\tal:\tGastro-esophageal\treflux\n\tdisease,\t\nLancet
|
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] |
disease,\t\nLancet\n\t381:1933,\t2013;\tKatz\tPO\tet\tal:\tGuidelines\tfor\tthe\tdiagnosis\tand\nmanagement\tof\tgastroesophageal\treflux\tdisease,\t\nAm\tJ\tGastrotenterol\n\t108:308,\t2013.\nBarrett’s\tesophagus\t(BE)\n\tis\ta\tprecancerous\tcondition\tin\twhich\tthe\tnormal\tsquamous\tepithelium
|
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is\ta\tprecancerous\tcondition\tin\twhich\tthe\tnormal\tsquamous\tepithelium\nof\tthe\tesophagus\tis\treplaced\tby\tan\tabnormal\tcolumnar-lined\tepithelium\tknown\tas\tspecialized\nintestinal\tmetaplasia\t(tissue\tthat\tis\tsimilar\tto\n\tthe\tintestinal\tlining).\tThe\texact\tcause\tof\tBE\tis
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] |
the\tintestinal\tlining).\tThe\texact\tcause\tof\tBE\tis\nunknown,\tbut\tGERD\tis\ta\trisk\tfactor\tfor\tthe\tcondition.\tThe\tprevalence\tof\tBE\tis\tbetween\t0.5%\tand\t2%\nbut\tis\testimated\tto\taffect\t1.6%\tto\t6.8%\tof\tthe\tgeneral\tpopulation\t(\nRunge\tet\tal,\t2015\n).\tPeople\twith\tBE\nare\tat\tincreased\trisk\tfor\ta\tcancer\tcalled\tesophageal\tadenocarcinoma,\twith\tincidence\trising
|
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] |
dramatically\tover\tthe\tpast\t40\tyears\tand\tspeculated\tto\tcontinue\n\tto\trise\tduring\tcoming\tdecades\t(\nThrift\nand\tWhiteman,\t2012\n).\tRisk\tfactors\tfor\tBE\tinclude\tprolonged\thistory\tof\tGERD-related\tsymptoms\n(more\tthan\t5\tyears),\tmiddle\tage,\twhite\tmale,\tobesity,\tsmoking,\tand\tfamily\thistory\tof\tBE\tor
|
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] |
adenocarcinoma\tof\tthe\tesophagus.\tEstrogen\tmay\tbe\tprotective\tand\taccount\tfor\tthe\tlower\tincidence\nof\tBE\tin\tfemales\t(\nAsanuma\tet\tal,\t2016\n).\nAbnormalities\tin\tthe\tbody\tsuch\tas\t\nhiatal\thernia\n\tmay\talso\tcontribute\tto\tGER\tand\tesophagitis.\tThe\nesophagus\tpasses\tthrough\tthe\tdiaphragm\tby\tway\tof\tthe\tesophageal\thiatus\tor\tring.\tThe\tattachment\tof
|
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] |
the\tesophagus\tto\tthe\thiatal\tring\tmay\tbecome\tcompromised,\tallowing\ta\tportion\tof\tthe\tupper\tstomach\nto\tmove\tabove\tthe\tdiaphragm.\t\nTable\t26.2\n\tdescribes\tthe\tfour\ttypes\tof\thiatal\thernia\tin\tgreater\tdetail.\nThe\tmost\tcommon\tsymptom\tof\thiatal\thernia\tis\theartburn.\n\tWhen\tacid\treflux\toccurs\twith\ta\thiatal
|
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When\tacid\treflux\toccurs\twith\ta\thiatal\nhernia,\tthe\tgastric\tcontents\tremain\tabove\tthe\thiatus\tlonger\tthan\tnormal.\tThe\tprolonged\tacid\nexposure\tincreases\tthe\trisk\tof\tdeveloping\tmore\tserious\tesophagitis.\t\nFig.\t26.2\n\tillustrates\ta\thiatal\nhernia\t\n(A)\n,\tand\tpostsurgical\treduction\t\n(B)\n.\tAs\tthe\thiatal\thernia\tenlarges,\tregurgitation\tmay\tbe\tmore
|
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] |
(B)\n.\tAs\tthe\thiatal\thernia\tenlarges,\tregurgitation\tmay\tbe\tmore\nprominent,\tespecially\twhen\tlying\tdown\tor\twhen\tbending\tover.\tEpigastric\n\tpain\toccurs\tin\tthe\tupper\nmiddle\tregion\tof\tthe\tabdomen\tafter\tlarge,\tenergy-dense\tmeals.\tWeight\treduction\tand\tdecreasing\nmeal\tsize\tcan\treduce\tthe\tnegative\tconsequences\tof\thiatal\thernia.\nFIG.\t26.2\nA,\n\tHiatal\thernia.
|
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] |
FIG.\t26.2\nA,\n\tHiatal\thernia.\t\nB,\n\tPostsurgical\treduction\tof\thiatal\thernia.\n\t\nSource:\n\t(Cleveland\tClinic,\tCleveland,\tOhio.)
|
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] |
TABLE\t26.2\nTypes\tof\tHiatal\tHernia\nType\t1\t(sliding\thiatal\nhernia)\nMost\tcommon\ttype;\tgastroesophageal\tjunction\tis\tpushed\tabove\tthe\tdiaphragm,\ncausing\ta\tsymmetric\therniation\tof\tthe\tproximal\tstomach\nType\t2\t(true\nparaesophageal\nhernia)\nFundus\tslides\tupward\tand\tmoves\tabove\n\tthe\tgastroesophageal\tjunction\nType\t3\t(mixed\nparaesophageal\nhernia)
|
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0.08521382510662079,
0.06531184166669846,
0.06360693275928497,
0.034230269491672516
] |
the\tgastroesophageal\tjunction\nType\t3\t(mixed\nparaesophageal\nhernia)\nCombined\tsliding\tand\tparaesophageal\therniation\nType\t4\t(complex\nparaesophageal\nhernia)\nLess\tcommon\tform;\tintrathoracic\therniation\tof\tother\torgans,\tsuch\tas\tthe\tcolon,\nand\tsmall\tbowel\tinto\tthe\thernia\tsac
|
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0.014516912400722504
] |
and\tsmall\tbowel\tinto\tthe\thernia\tsac\nPatients\twith\ttype\t3\t(mixed\tparaesophageal)\thiatal\thernia\tmay\tpresent\twith\tsevere\tchest\tpain,\nretching,\tvomiting,\tand\t\nhematemesis\n\t(vomiting\tof\tblood),\tas\tthese\thernias\tcan\ttwist\tand\tcause\nstrangulation\tin\tthe\tchest,\tresulting\tin\ta\tsurgical\temergency.\tSome\tpatients\tcan\tpresent\twith\tiron
|
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] |
deficiency\tanemia\twithout\tacute\tbleeding\tbecause\tthe\tdiaphragm\tbecomes\tso\tirritated\tthat\tthe\npatient\tmay\tdevelop\tchronic\tblood\tloss.\nMedical\tand\tsurgical\tmanagement\nThe\tprimary\tmedical\ttreatment\tof\tesophageal\treflux\tis\tsuppression\tof\tacid\n\tsecretion.\tThe\taim\tin
|
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] |
secretion.\tThe\taim\tin\nacid-suppression\ttherapy\tis\tto\traise\tthe\tgastric\tpH\tabove\t4\tduring\tperiods\twhen\treflux\tis\tmost\tlikely\nto\toccur.\tProton\tpump\tinhibitors\t(PPIs),\twhich\tdecrease\tacid\tproduction\tby\tthe\tgastric\tparietal\tcell,\nhave\tbeen\tassociated\twith\tsuperior\thealing\trates\tand\tdecreased\trelapses\t(\nKatz\tet\tal,\t2013\n).\tMilder
|
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] |
Katz\tet\tal,\t2013\n).\tMilder\nforms\tof\treflux\tare\tmanaged\tby\tH\n2\n\treceptor\t(a\ttype\tof\thistamine\treceptor\n\ton\tthe\tgastric\tparietal\tcell)\nantagonists\tand\tantacids,\twhich\tbuffer\tgastric\tacid\tin\tthe\tesophagus\tor\tstomach\tto\treduce\nheartburn.\tProkinetic\tagents,\twhich\tincrease\tpropulsive\tcontractions\tof\tthe\tstomach,\tmay\tbe\tused\tin
|
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] |
persons\twith\tdelayed\tgastric\temptying.\tA\ttrial\tof\tbaclofen,\ta\tgamma-amino\tbutyric\tacid\t(GABA)\nagonist,\tcan\tbe\tconsidered\tin\tpatients\twith\tobjective\tdocumentation\tof\tcontinued\tsymptomatic\n\treflux\ndespite\toptimal\tPPI\ttherapy\t(\nKatz\tet\tal,\t2013\n).\tHowever,\tthere\thave\tnot\tbeen\tlong-term\tdata\npublished\tregarding\tefficacy\tof\tbaclofen\tin\tGERD.\tRefer\tto
|
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] |
published\tregarding\tefficacy\tof\tbaclofen\tin\tGERD.\tRefer\tto\t\nTable\t26.3\n\tfor\tmedications\tcommonly\nused\tin\tupper\tGI\tdisorders.\tSee\t\nAppendix\t13\n\tfor\tmore\tinformation\tabout\tthese\tmedications.\nTable\t26.3\nCommon\tMedications\tUsed\tin\tthe\tTreatment\tof\tUpper\tGastrointestinal\tTract\tDisorders\nType\tof\nMedication\nCommon\tNames\nMedication\tFunction\nAntacids
|
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] |
Type\tof\nMedication\nCommon\tNames\nMedication\tFunction\nAntacids\nMagnesium,\tcalcium,\tor\naluminum\tbound\tto\ncarbonate,\thydroxide,\tor\nphosphate\nBuffers\tgastric\tacid\nAntigas\nSimethicone\nLowers\tsurface\ttension\tof\tgas\tbubbles\nAntidiarrheal\nDiphenoxylate\nLoperamide\nOpium\tpreparations\nDecreased\tgastrointestinal\t(GI)\ttract\tmotility\tto\tinduce
|
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] |
Decreased\tgastrointestinal\t(GI)\ttract\tmotility\tto\tinduce\nlower\tstool\tvolume\toutput\nAntidumping\nAcarbose\nDelays\tcarbohydrate\tdigestion\n\tby\tinhibiting\talpha-glycoside\nhydrolase,\twhich\tinterferes\twith\tconversion\tof\tstarch\tto\nmonosaccharides\nAntisecretory\nOctreotide\t(somatostatin\nanalog)\nSomatostatin
|
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] |
Antisecretory\nOctreotide\t(somatostatin\nanalog)\nSomatostatin\nInhibits\trelease\tof\tinsulin\tand\tother\tgut\thormones;\tslows\nrate\tof\tgastric\temptying\tand\tsmall\tintestine\ttransit\ttime;\nand\tincreases\tintestinal\twater\tand\tsodium\tabsorption\nH\n2\n\tblocker\nCimetidine\nRanitidine\nFamotidine\nNizatidine\nBlocks\tthe\taction\tof\thistamine\ton\tparietal\tcells,\tdecreasing
|
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] |
Blocks\tthe\taction\tof\thistamine\ton\tparietal\tcells,\tdecreasing\nthe\tproduction\tof\tacid\nProkinetic\nMetoclopramide\nErythromycin\nDomperidone\nIncreases\tcontractility\tof\tthe\tstomach\tand\tshortens\tgastric\nemptying\ttime\nProton\tpump\ninhibitor\n(PPI)\nOmeprazole\nLansoprazole\nEsomeprazole\nPantoprazole\nDexlansoprazole\nRabeprazole\nInhibits\tacid\tsecretion
|
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] |
Pantoprazole\nDexlansoprazole\nRabeprazole\nInhibits\tacid\tsecretion\nOf\tpatients\twith\tsevere\tGERD,\t5%\tto\t10%\tdo\n\tnot\trespond\tto\tmedical\ttherapy.\tThe\t\nNissen\nfundoplication\n\twas\tfirst\tdescribed\tas\ta\ttreatment\tfor\tsevere\treflux\tesophagitis\tin\t1956\tand\tis\tstill
|
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] |
the\tmost\tcommonly\tperformed\tantireflux\tsurgery\t(\nFig.\t26.3\n).\tDuring\tthis\tprocedure,\twhich\tcan\tbe\ndone\tusing\teither\topen\tor\ta\tlaparoscopic\ttechnique,\tthe\tfundus\tor\ttop\tportion\tof\tthe\tstomach\tis\nwrapped\t360\tdegrees\taround\tthe\tlower\tesophagus\tand\tsutured\tin\n\tplace\tto\tlimit\treflux\t(see\t\nFig.\n26.3
|
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] |
place\tto\tlimit\treflux\t(see\t\nFig.\n26.3\n).\tSurgical\ttherapy\tis\tconsidered\tfor\tindividuals\tfor\twhom\tmedical\tmanagement\thas\tbeen\nunsuccessful,\tthose\twho\topt\tfor\tsurgery\tto\tavoid\tlifelong\tneed\tfor\tmedication\tto\tcontrol\tsymptoms,\nthose\texperiencing\tmore\tserious\tcomplications\t(BE,\tpeptic\tstricture),\tand\tthose\twho\thave
|
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] |
extraesophageal\tmanifestations\tthat\tinclude\tboth\tlaryngeal\tand\tpulmonary\tsymptoms\t(throat-\nclearing,\n\thoarseness,\tpostnasal\tdrip,\tcough,\tshortness\tof\tbreath,\tasthma)\t(\nYates\tand\tOelschlager,\n2015\n).\tAs\tmany\tas\t18%\tof\tthose\tundergoing\tsurgery\twill\tneed\ta\trepeat\toperation\tdue\tto
|
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] |
fundoplication\tfailure.\tUnfortunately,\tfor\tthese\tpatients,\tquality\tof\tlife\tscores\tdecrease\tand\tthere\tis\nless\timprovement\tof\tdysphagia\twith\tthe\tsecond\tprocedure,\tleading\tsurgeons\tto\tconsider\tmore\ninvasive\tsurgeries\tsuch\tas\n\tRoux-en-Y\tor\tshort\tcolon\tinterposition\t(\nWilshire\tet\tal,\t2016\n).\tSurgical
|
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] |
Wilshire\tet\tal,\t2016\n).\tSurgical\napproaches\tin\tchildren\tare\treserved\tfor\tthose\twho\thave\tintractable\tsymptoms\tunresponsive\tto\nmedical\ttherapy\tor\twho\tare\tat\trisk\tfor\tlife-threatening\tcomplications\tof\tGERD\t(\nLightdale\tand\nGremse,\t2013\n).\tRefer\tto\t\nBox\t26.2\n\tfor\tdietary\tguidelines\tafter\tNissen\tfundoplication.\nFIG.\t26.3\nNissen\tfundoplication.\n\t\nSource:
|
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] |
FIG.\t26.3\nNissen\tfundoplication.\n\t\nSource:\n\t(Cleveland\tClinic,\tCleveland,\tOhio.)\nBOX\t26.2\nDietary\tGuidelines\tAfter\ta\tNissen\tFundoplication\n1.\t\nStart\tclear\tliquid\tdiet\tafter\tsurgery.\n2.\t\nAdvance\toral\tdiet\tto\tsoft,\tmoist,\tsolid\tfoods.\tStarting\tsolids\tcould\tbe\tbefore\tleaving\tthe\nhospital\tor\twritten\tin\thospital\tdischarge\tinstructions.\n3.
|
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hospital\tor\twritten\tin\thospital\tdischarge\tinstructions.\n3.\t\nFollow\tsoft,\tmoist\tfoods\tdiet\tfor\tabout\t2\tmonths.\n\tFoods\tmust\tbe\tsoft\tto\tpass\tthrough\tthe\nesophagus.\n4.\t\nConsume\tsmall,\tfrequent\tmeals.\n5.\t\nSwallow\tsmall\tbites\tof\tfood\tand\tchew\tthoroughly\tto\tallow\tan\teasy\tpassage\tthrough\tthe
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esophagus\tand\tavoid\tuse\tof\tstraw\tto\tconsume\tliquids.\tDrink\tslowly.\n6.\t\nAvoid\tfoods\tand\tbeverages\tthat\tmay\tcause\tbackflow\tof\tstomach\tcontents.\tThis\tconsists\tof\ncitrus\tfruits\tand\tjuices,\ttomato,\tpineapple,\talcohol,\tcaffeine,\n\tchocolate,\tcarbonated\nbeverages,\tpeppermint\tor\tspearmint,\tfatty\tor\tfried\tfoods,\tspicy\tfoods,\tvinegar\tor\tvinegar-
|
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] |
containing\tfoods.\n7.\t\nAvoid\tdry\tfoods\tthat\tare\thard\tto\tpass\tthrough\tthe\tesophagus,\tsuch\tas\tbread,\tsteak,\traw\nvegetables,\trolls,\tdry\tchicken,\traw\tfruits,\tpeanut\tbutter,\tother\tdry\tmeats,\tor\tanything\twith\nskin,\tseeds,\tor\tnuts.\n8.\t\nAvoid\tany\tfood\tthat\tmay\tcause\tdiscomfort.\n9.\t\nAfter\t2\tmonths,
|
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] |
8.\t\nAvoid\tany\tfood\tthat\tmay\tcause\tdiscomfort.\n9.\t\nAfter\t2\tmonths,\n\tstart\tto\tincorporate\tnew\tfoods\tinto\tthe\tdiet.\tTry\tone\tnew\tfood\titem\tor\nbeverage\tat\ta\ttime.\tBy\t3–6\tmonths,\tpatient\tshould\tbe\table\tto\ttolerate\tmost\tfoods.\n10.\t\nConsult\tdoctor\tor\tdietitian\tif\thaving\tdifficulty\teating\tor\tlosing\tweight.
|
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] |
Lifestyle\tmodifications\tand\tmedical\tnutrition\ttherapy\nThe\tfirst\tstep\tin\tsymptom\tmanagement\tof\tGERD\tshould\tconsist\tof\tchanges\tin\tlifestyle,\tincluding\tdiet.\nA\trecent\tsmall\tclinical\ttrial\tfound\timprovements\tin\tNERD\tparticipants\twith\tthe\taddition\tof\tpsyllium
|
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fiber\tinto\tthe\tdiet\tthree\ttimes\tdaily\tfor\ta\ttotal\tof\t12.5\tgrams\tsoluble\tfiber\tper\tday.\tThose\tenrolled\tin\nthe\tstudy\twere\tselected\tif\tthey\tpreviously\tate\ta\tlow\t(<20\tg/day)\tfiber\tdiet\tat\tbaseline.\tDuring\tthe\nstudy,\tno\tother\tdietary\tchanges\twere\tmade,\tand\tPPIs,\tH\n2\n\tblockers,\tor\tprokinetics\twere\tnot\tallowed.
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] |
2\n\tblockers,\tor\tprokinetics\twere\tnot\tallowed.\nThe\tresult\tdemonstrated\tthat\tdietary\tfiber\tincreased\tthe\tLES\tpressure\tand\tdecreased\ttotal\treflux\nepisodes\tin\tparticipants\t(\nMorozov\tet\tal,\t2018\n).\tBesides\tdiet,\tother\timportant\tfactors\tthat\ttrigger\nreflux\tsymptoms\tare\tcaffeine,\talcohol,\ttobacco,\tand\tstress.\tInitial\trecommendations\tshould\tfocus\ton
|
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] |
meal\tsize\tand\tcontent.\tEating\tsmall\trather\tthan\tlarge\tmeals\treduces\tthe\tprobability\tthat\tgastric\ncontents\n\twill\treflux\tinto\tthe\tesophagus.\nCertain\tfoods\tcan\tlower\tLES\tpressure,\tincluding\tcoffee\tand\tcarminatives\tsuch\tas\tpeppermint,\tbut
|
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] |
more\tresearch\tis\tneeded\tto\testablish\ttheir\tclinical\tsignificance\tin\tGERD\twhen\tused\tin\tnormal\tor\nsmall\tamounts\t(\nJarosz\tand\tTaraszewska,\t2014\n;\t\nDossett\tet\tal,\t2017\n).\tFermented\talcoholic\tbeverages\n(such\tas\tbeer\tand\twine)\tstimulate\tthe\tsecretion\tof\tgastric\tacid\tand\tshould\n\tbe\tlimited.\tCarbonated
|
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0.10716264694929123,
0.030686743557453156,
0.02971082553267479,
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] |
be\tlimited.\tCarbonated\nbeverages\tenhance\tgastric\tdistention,\twhich\tincreases\ttransient\tLES\trelaxations.\tHighly\tacidic\tfoods\nsuch\tas\tcitrus\tjuices\tand\ttomatoes\tshould\tbe\tavoided\tbecause\tthey\tcause\tpain\twhen\tthe\tesophagus\tis\nalready\tinflamed.\nThe\trole\tof\tspices\tin\tthe\tpathologic\tconditions\trelated\tto\tupper\tGI\tdisorders\tis\tnot\tclear.\tWhen
|
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] |
study\tparticipants\twith\tGERD\twere\tinitially\texposed\tto\ta\n\tcapsaicin-containing\tred\tpepper\tsauce,\tan\nincrease\tin\tboth\theartburn\tsensation\tand\tan\tenhancement\tof\tsecondary\tperistalsis\t(triggered\tby\nesophageal\tdistention\ton\tintake\tof\tfood\tor\tbeverage)\toccurred.\tHowever,\trepeating\tthe\tsame
|
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exposure\tled\tto\ta\treversal\tof\tthese\teffects,\tand\tmay\tindicate\tlowered\tprotection\tfor\tthe\tesophagus\ndue\tto\tdelayed\tacid\tclearance\tin\tthose\twith\tGERD\t(\nYi\tet\tal,\t2016\n).\tChewing\n\tgum\thas\tbeen\tshown\tto\nincrease\tsalivary\tsecretions,\twhich\thelp\traise\tesophageal\tpH,\tbut\tstudies\thave\tnot\tdemonstrated\tits
|
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efficacy\tcompared\twith\tother\tlifestyle\tmeasures.\tLimiting\tor\tavoiding\taggravating\tfoods\tmay\nimprove\tsymptoms\tin\tsome\tindividuals.\tThus\trecommendations\tare\tto\thave\ta\tgenerally\thealthy\tdiet\nand\tto\tavoid\tfood\titems\tthat,\tin\tthe\texperience\tof\tthe\tpatient,\ttrigger\tsymptoms.\nObesity
|
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by\t6\tto\t8\tinches\tusing\tblocks\tunder\tbed\tposts\tis\trecommended.\tFurther,\tfrequent\tbending\tover\nshould\tbe\tavoided.\n\tUse\tof\tloose-fitting\tgarments\tin\tthe\twaist\tarea\tis\talso\tthought\tto\tdecrease\tthe\trisk\nof\treflux.\nA\tfew\trecent\tstudies\thave\tshown\tan\timprovement\tof\tGERD\tsymptoms\twith\ta\tlow\tsugar\tand/or\tlow
|
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carbohydrate\tdiet.\tOne\tsmall\tstudy\tconducted\tin\tTaiwan\tfound\tstatistical\tdifferences\tin\tsymptoms\tof\nGERD\tpatients\tbased\ton\twhether\ta\t500\tmL\tliquid\tmeal\tprovided\t84.8\tgrams\tversus\t178.8\tgrams\tof\ncarbohydrates,\n\twhile\tboth\tcontained\tequal\tamounts\tof\tprotein\tand\tfat.\tAcid-reducing\tmedications
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] |
were\tprohibited\tduring\tthe\tstudy\tperiod.\tEndoscopy\texaminations,\t24-hour\tpH\tmonitoring,\tand\nreflux\tsymptoms\twere\trecorded\tand\tincluded\tbut\twere\tnot\tlimited\tto\theartburn,\tacid\tregurgitation,\nand\tabdominal\tdiscomfort.\tFor\tthe\tparticipants\tin\tthe\tlow-carbohydrate\tgroup,\tshorter\tacid\treflux\nperiods\tand\tfewer\tacid-reflux\n\tsymptoms\twere\tdemonstrated\t(
|
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0.06598622351884842,
0.10272593051195145,
0.04861843213438988,
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] |
periods\tand\tfewer\tacid-reflux\n\tsymptoms\twere\tdemonstrated\t(\nWu\tet\tal,\t2018\n).\tAlthough\tthere\tare\nlimited\tstudies\texploring\tthe\timpact\tof\tthe\tlow-carbohydrate\tdiet\ton\tresolution\tof\tGERD\tsymptoms,\npromising\tresults\tsuch\tas\tthese\twarrant\tfurther\tresearch.\nUse\tof\ttobacco\tproducts\tis\tcontraindicated\twith\treflux.\tCigarette\tsmoking\tshould\tbe\tstopped
|
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] |
because\tit\tis\tassociated\twith\tdecreased\tLES\tpressure\tand\tdecreased\tsalivation,\tthus\n\tcausing\nprolonged\tacid\tclearance.\tSmoking\ttobacco\tproducts\talso\tcompromises\tGI\tintegrity\tand\tincreases\nthe\trisk\tof\tesophageal\tand\tother\tcancers.\tLifestyle\tchanges\tto\ttreat\tGERD\tin\tinfants\tmay\tinvolve\ta
|
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combination\tof\tfeeding\tchanges\tand\tpositioning\ttherapy.\tModifying\tthe\tmaternal\tdiet\tif\tinfants\tare\nbreastfed,\tchanging\tformulas,\tand\treducing\tthe\tfeeding\tvolume\twhile\tincreasing\tthe\tfrequency\tof\nfeedings\n\tmay\tbe\teffective\tstrategies\tto\taddress\tGERD\tin\tinfants.\tThickened\tfeedings\tappear\tto
|
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decrease\tobserved\tregurgitation\trather\tthan\tthe\tactual\tnumber\tof\treflux\tepisodes.\tLittle\tis\tknown\nabout\tthe\teffect\tof\tthickening\tformula\ton\tthe\thistory\tof\tinfantile\treflux\tor\tthe\tpotential\tallergenicity\nof\tcommercial\tthickening\tagents\t(\nLightdale\tand\tGremse,\t2013\n).\nIdentification\tand\ttreatment\tof\tthe\tmechanism
|
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] |
).\nIdentification\tand\ttreatment\tof\tthe\tmechanism\n\tunderlying\tthe\tGERD\tis\tthe\tfirst\tline\tof\ttherapy.\tA\ncombined\tapproach\tof\tlifestyle\tchanges,\tnutrition,\texercise,\tand\tstress\treduction\tcan\tbe\teffective\tin\nreducing\tsymptoms\tin\tsome\tpatients.\t\nBoxes\t26.3\n\tand\t\n26.4\n\tcontain\tinformation\tabout\tdiet\tand
|
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] |
Boxes\t26.3\n\tand\t\n26.4\n\tcontain\tinformation\tabout\tdiet\tand\nlifestyle\tmodifications\tand\tintegrative\tapproaches\tto\thelp\treduce\tsymptoms\tof\tGERD.\nBOX\t26.3\nNutrition\tCare\tGuidelines\tfor\tReducing\tGastroesophageal\nReflux\tand\tEsophagitis\n1.\t\nNutrition\tRecommendations:\n•\t\nAvoid\tlarge,\thigh-fat\tmeals\tand\tdecrease\tgreasy\tfoods.\n•
|
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] |
•\t\nAvoid\tlarge,\thigh-fat\tmeals\tand\tdecrease\tgreasy\tfoods.\n•\t\nAvoid\teating\t2\tto\t3\thours\tbefore\tlying\tdown.\n•\t\nAvoid\tchocolate,\tmint,\ttomatoes,\tand\ttomato\tproducts.\n•\t\nAvoid\tcaffeine-containing\tfoods\tand\tbeverages.\n•\t\nAvoid\talcoholic\tbeverages.\n•\t\nAvoid\tacidic\tand\thighly\tspiced\tfoods.\n•\t\nConsume\ta\twell-balanced\tdiet\twith\tadequate\tfiber.\n•
|
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] |
•\t\nConsume\ta\twell-balanced\tdiet\twith\tadequate\tfiber.\n•\t\nConsider\tweight\tloss\tif\toverweight\tor\tobese.\n•\t\nChoose\tsmaller,\tmore\tfrequent\tmeals\trather\tthan\tthree\tlarger\tmeals\teach\tday.\n2.\t\nLifestyle\tRecommendations:\n•\t\nElevate\tthe\thead\tof\tbed\tby\t6\tto\t8\tinches\tfor\tindividuals\twho\thave\treflux\tepisodes\tat\nnight.\n•
|
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0.026224054396152496,
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0.11361883580684662,
0.008786994032561779,
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0.050062451511621475,
0.020883159711956978,
0.03386244177818298,
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0.012693600729107857,
0.11022232472896576,
0.05839063972234726,
0.04271382465958595,
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] |
night.\n•\t\nQuit\tsmoking\tand\tavoid\tsecondhand\tsmoke\tand\talcoholic\tbeverages.\n•\t\nReduce\toverall\tstress\tlevels\twhen\tpossible.\n•\t\nWear\tloose-fitting\tclothing\n\taround\tthe\tstomach\tarea,\tas\ttight\tor\tconstricting\tclothing\ncan\tworsen\treflux.\nData\tfrom\tNational\tDigestive\tDiseases\tInformation\tClearinghouse:\t\nGastroesophageal\tReflux\t(GER)\tand
|
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] |
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