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Pathophysiology of Gastro Esophageal Reflux Disease Commonly known as GERD Vicki Orzel RN/BSN MSN Student Alverno College Spring 2006 Clip Art derived from Microsoft Office [email protected]

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Vicki orzel rn bsn msn student alverno college spring 2006 l.jpg

Pathophysiology of Gastro Esophageal Reflux Disease Commonly known as GERD

Vicki Orzel RN/BSN

MSN Student

Alverno College

Spring 2006

Clip Art derived from

Microsoft Office

[email protected]


Slide2 l.jpg

** Click on the arrow at the bottom

right to move forward **

** The arrow at the bottom left will

take you back only one slide **

** Click on the gold button

in the center, to take you

back to the sequence page, which

similar to a table of contents**


Slide3 l.jpg

Taking a Closer

Look into

GERD.

Clip Art derived from

Microsoft Office


Slide4 l.jpg

Sequence of learning tutorial,

Click on one of the shapes for shortcut.

STRESS RESPONSE

BASIC

ANATOMY

WHAT GERD

IS

PHARMOCOGENOMICS

GENETICS

CELL GROWTH

AND DEATH

INFLAMMATION

ACKNOWLEDGEMENTS

SUMMARY


Slide5 l.jpg

“Population based survey revealed that 44 % of the population reported monthly heartburn and 19.8 % suffered from heartburn or acid regurgitation at least once a week”.

(Zuckschwerdt, W. 2001)

Clip Art derived from

Microsoft Office


Slide6 l.jpg

“ GERD is more common in whites compared with other ethnic groups. However, the prevalence is increasing in Asians”.(Fennerty, 2003)

It is also more common in women, however men & people over the age of 60 develop more complications.

(Fennerty, 2003)

Clip Art derived from

Microsoft Office


Basic anatomy l.jpg
BASIC ANATOMY groups. However, the prevalence is increasing in Asians”.

“The upper GI or gastro-intestinal

tract consists of the:

Mouth

Pharynx

Esophagus

Stomach

The small & large intestines form

the lower GI tract”.

(Porth, 1998 )


Slide8 l.jpg

The upper GI Tract is sometimes groups. However, the prevalence is increasing in Asians”.

referred to as the Alimentary canal.

(wikipedia)

Clip Art derived from

Microsoft Office


Slide9 l.jpg

Once any food enters the mouth, it groups. However, the prevalence is increasing in Asians”.

moves into the pharynx, which

is the back of the throat.

(Porth,1998)


Slide10 l.jpg

Food is passed from the groups. However, the prevalence is increasing in Asians”.

pharynx into the esophagus by a

mechanism called peristalsis. This

propelling motion is carried out

by the muscles and the central nervous system. (Porth, 1998)


Peristalsis continues in the esophagus l.jpg

The food is carried groups. However, the prevalence is increasing in Asians”.

from the esophagus

to the stomach

where acid

production is formed.

(Porth,1998)

Image with permission from MDA

Peristalsis continues in the esophagus.


Slide12 l.jpg

“The esophagus is very groups. However, the prevalence is increasing in Asians”. muscular and collapses when empty. It is 10 inches or 25cm in length” (Porth, 1998)


Slide13 l.jpg

The esophagus is sometimes referred to as the “food tube” or the gullet. It extends from the pharynx, which is the back of the throat and goes through the diaphram to the stomach.

Clip Art derived from

Microsoft Office


The esophagus is posterior to behind the trachea l.jpg
The esophagus is posterior tube” or the gullet. It extends from the pharynx, which is the back of the throat and goes through the diaphram to the stomach. to (behind) the trachea

Image with permission from Bristol-Meyers Squibb


The esophagus produces bicarbonate and mucus kahrilas 2003 l.jpg
“The esophagus produces tube” or the gullet. It extends from the pharynx, which is the back of the throat and goes through the diaphram to the stomach. bicarbonate and mucus”.(Kahrilas, 2003)

“The bicarbonate buffers the acid

and mucus forming a protective

barrier”.(Kahrilas, 2003)

Clip Art derived from

Microsoft Office


Slide16 l.jpg

This creates an environment in the esophagus of a higher pH than that of the stomach. The pH in the esophagus is normally about 7-8, whereas the pH in the stomach is generally 2-4. (Kahrilas, 2003)


Ph stands for potential of hydrogen l.jpg
pH stands for potential of hydrogen. than that of the stomach. The pH in the esophagus is normally about 7-8, whereas the pH in the stomach is generally 2-4.

Hydrogen is what causes materials to become acidic. 7 is considered neutral; anything under 7 is considered acidic. (Porth, 1998)


Slide18 l.jpg

There are specialized cells deep in the stomach lining that affect the rate of acid production. The primary cells which contribute to acid production are known as parietal cells. (Kahrilas, 2003)

Clip Art derived from

Microsoft Office


Slide19 l.jpg

The binding of these 3 receptors in the that affect the rate of acid production. The primary cells which contribute to acid production are known as parietal cells. parietal cells initiates the process of acid production. (Kahrilas, 2003)


The primary function of the activated pumps are to l.jpg
“The primary function of the that affect the rate of acid production. The primary cells which contribute to acid production are known as parietal cells. activated pumps are to :

Each gastric parietal cell contains about 1 million acid pumps.

Exchange hydrogen ions from the parietal cells to potassium using energy derived from splitting ATP.”

(Kahrilas, 2003)

Clip Art derived from

Microsoft Office


Slide21 l.jpg

Ions exchange at different rates based that affect the rate of acid production. The primary cells which contribute to acid production are known as parietal cells.

on the permeability of the parietal

cells. The rate influences the

intracellular pH, resulting in

an environment of acidity or alkalinity

of the cells of the stomach. (Kahrilas, 2003)


Slide22 l.jpg

“The stomach produces an average of 2 liters of HCL a day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”. (Kahrilas 2003)

Clip Art derived from

Microsoft Office


Slide23 l.jpg

There is a rare disorder, called day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

Zollinger-Ellison syndrome:

With this, the body produces an

excessive amount of acid, this

can increase the risk of

GERD. (CNN.com)


The esophagus is divided into l.jpg

Upper day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

It has a sphincter to prevent air from entering the esophagus during respirations. The sphincter generally only opens for food to pass.

Lower

It has a sphincter that opens while food is being passed into the stomach. It is known as the LES, lower esophageal sphincter.

The esophagus is divided into:

( Porth, 1998)


Click on true or false l.jpg
Click on day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”. True or False

The gullet is part of the

stomach.


Slide26 l.jpg

Sorry, You are incorrect. day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

The gullet is another name for

the esophagus.

Clip Art derived from

Microsoft Office


Slide27 l.jpg

Yes, you are correct ! day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

The gullet is another name for

the esophagus.

Clip Art derived from

Microsoft Office


Click on true or false28 l.jpg
Click on day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”. Trueor False

The esophagus is in front

of the trachea.


Slide29 l.jpg

Sorry, you are incorrect. day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

The esophagus

is behind (posterior)

the trachea.

Image with permission from

Bristol-Meyers Squibb.

Clip Art derived from

Microsoft Office


Slide30 l.jpg

Yes, you are correct ! day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

The esophagus

is behind (posterior)

the trachea

Image with permission from

Bristol-Meyers Squib.

Clip Art derived from

Microsoft Office


Click on true or false31 l.jpg
Click on day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”. True or False

The upper sphincter of the esophagus is in the upper GI & the lower sphincter is the lower GI.


Slide32 l.jpg

Sorry, you are incorrect. day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

The entire esophagus is in the upper

GI. The upper GI tract consists of

the: mouth

pharynx

esophagus

stomach

The small & large intestines form the

lower GI tract.

Clip Art derived from

Microsoft Office


Slide33 l.jpg

Yes, you are correct! day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

The entire esophagus is in the upper GI. The upper GI tract consists of the: mouth

pharynx

esophagus

stomach

The small & large intestines form the

lower GI tract.

Clip Art derived from

Microsoft Office


Click on true or false34 l.jpg
Click on day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”. True or False

There are a million acid pumps in

each gastric parietal cell.


Slide35 l.jpg

Sorry, you are incorrect. day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

There are 1 million acid pumps in

each gastric parietal cell.

Clip Art derived from

Microsoft Office


Slide36 l.jpg

Yes, you are correct! day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

There are 1 million acid pumps in

each gastric parietal cell.

Clip Art derived from

Microsoft Office


What gerd is l.jpg
What GERD is day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

It is quite a complex process, my goal is to simplify it for you. First, let’s break it down to the words it is made up of: gastro = stomach

esophogeal = food tube

reflux = back flow

disease = abnormal condition

of physiologic functioning.


Slide38 l.jpg

The Lower day, which in combination with the protein-splitting enzyme pepsin, breaks down chemicals in food”.

Esophageal

Sphincter is

The primary

focus relating

to GERD.

Image with permission from Dr. Scott Tenner


Slide39 l.jpg

If the Lower Esophageal Sphincter (LES) is not working properly creating a dysfunction – the acid from the stomach can backflow into the esophagus. (Porth, 1998)


Slide40 l.jpg

Images with properly creating a dysfunction – the acid from the stomach can backflow into the esophagus.

permission from

Life Enhancement


In addition to a dysfunction of the lower esophageal sphincter les another factor is l.jpg
In addition to a dysfunction of the lower esophageal sphincter (LES) Another factor is:

Percentage of time the esophagus is exposed to a low pH. Clearance of the acid depends on peristalsis & exposure to the saliva. (Porth, 1998)


Slide42 l.jpg

Image with permission from sphincter (LES)

Healthy Living

This uncomfortable feeling can sometimes be confused with other conditions, even a heart attack.

People with this dysfunction, often experience an uncomfortable feeling in the chest, neck, and throat area due to acid exposure.


Slide43 l.jpg

Sometimes, just drinking water may sphincter (LES)

help relieve the symptoms, by

washing the irritating acids back

into the stomach. (Porth, 1998)


Slide44 l.jpg

This discomfort can be sphincter (LES) precipitated by lifestyle, diet, and even certain medications. (Kaynard,, Flora, 2001)


Lifestyle l.jpg
Lifestyle sphincter (LES)

  • “Smoking – Inhibits saliva, may also increase acid production & weaken the LES”.

  • Certain exercising & bending – that may increase the abdominal pressure.

  • “Wearing of tight clothing – increases the abdominal pressure”.

  • Lying flat after a meal – relaxes the muscles making susceptibility for reflux.

    (Kaynard, A., Flora, A., 2001)

Clip Art derived from

Microsoft Office


Slide46 l.jpg
Diet sphincter (LES)

  • “Fatty, greasy foods - take longer to digest keeping food in the stomach longer”.

  • “Peppermint, spearmint, and chocolate weaken the LES”.

  • “Carbonated and alcoholic beverages increase the acidity in the stomach”.

  • Large meal portions – produce large acid levels.

  • Citrus, onions, and acid from tomatoes can be irritating to the esophagus. (Howard, B., 2004)

Clip Art derived from

Microsoft Office


Medications that relax the les l.jpg

Benzodiazepines sphincter (LES)

Theophylline

Narcotics containing codeine.

Calium channel Blockers

Nitroglycerine

Anticholinergics

Potassium supplements

Iron supplements

NSAIDS

Fosamax

Erythromycin

(CNN)

“Medications that relax the LES”

Clip Art derived from

Microsoft Office


The 3 mechanisms during swallowing that keep acid out of the esophagus include l.jpg
The 3 mechanisms during swallowing that keep acid out of the esophagus include:

  • “Swallowed saliva which helps neutralize stomach acid”.

  • “Sweeping muscles contractions that act to cleanse the lower esophagus of stomach acid”.

  • Protective contracture of the LES

    (Jackson Gastroenterology - 2005)


The 3 mechanisms of the lower esophageal sphincter les which prevent backflow are l.jpg
The 3 mechanisms of the lower esophagus include: esophageal sphincter (LES) which prevent backflow are:

  • Pressure in the LES is greater than that of the stomach.

  • High levels of Acetylcholine, a neurotransmitter increases constriction of the LES.

  • Gastrin, a hormone also increases constriction of the LES.

    (Porth 1998 )


Some conditions that can interfere with the 3 mechanisms of the lower esophageal sphincter les l.jpg
Some conditions that can interfere with the 3 mechanisms of the Lower Esophageal Sphincter (LES):

  • OBESITY - “excess weight puts extra pressure on the stomach & diaphragm”. (CNN.com)

  • Pregnancy – “results in greater pressure on the stomach & also has a higher level of progesterone. This hormone relaxes many muscles, including the LES”. (CNN.com)

  • ASTHMA – it is unsure why, but, is believed that the coughing leads to pressure changes on the diaphragm. (CNN.com)

  • HIATAL HERNIA – which is the following topic.


Slide51 l.jpg

In addition to the 3 swallowing mechanisms & the 3 mechanisms of the LES – anatomical structures certainly play a role in the development of GERD.


A hiatal hernia is an anatomical abnormality l.jpg
A hiatal hernia is an mechanisms of the LES – anatomical structures certainly play a role in the development of GERD. anatomical abnormality

“In individuals with hiatal hernia, the opening of the esophageal hiatus is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest.”(Kahrilas, 2003)


Slide53 l.jpg

“The diaphragm supports and puts pressure on the sphincter to keep it closed when you’re swallowing”.

“But a hiatal hernia raises the sphincter above the diaphragm, reducing pressure on the valve. This causes the sphincter muscle to open at the wrong time”. (MayoClinic.com)

Clip Art derived from

Microsoft Office


Do you think genetics is a factor l.jpg
Do you think Genetics is a sphincter to keep it closed when you’re swallowing”. factor?

There is evidence that genetics is a factor in pediatric patients. This is reported in the Journal of the American Medical Association from the July issue in 2000. (Spice, B., 2000)

Clip Art derived from

Microsoft Office


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“The specific gene has not been sphincter to keep it closed when you’re swallowing”.

identified as of yet, however research

has narrowed it to a portion of

chromosome 13”

(Hu, Fen Ze MS; et al 2000)

Clip Art derived from

Microsoft Office


Slide56 l.jpg

As far as adults, studies have been sphincter to keep it closed when you’re swallowing”.

performed on identical twins who

share the same genes & it has been

identified that there is a 43%

chance of genetic influence.

( MedicineNet.com)

Clip Art derived from

Microsoft Office


Click on true or false57 l.jpg
Click on sphincter to keep it closed when you’re swallowing”.True or False

GERD can sometimes cause a discomfort in the chest, confusing it

with a heart attack.


Image with permission from healthy living l.jpg

People with GERD can experience an uncomfortable feeling in the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.

Image with permission from Healthy Living

Sorry, you are incorrect.

Clip Art derived from

Microsoft Office


Image with permission from healthy living59 l.jpg
Image with permission from the neck, chest, & throat area. This can be confused with other diseases, even a heart attack. Healthy Living

Yes, You are correct!

People with GERD can experience an uncomfortable feeling in the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.

Clip Art derived from

Microsoft Office


Click on true or false60 l.jpg
Click on the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.True or False

Taking codeine for the pain, will help

relieve the discomfort

experienced with GERD.


Slide61 l.jpg

Sorry, you are incorrect the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.

Narcotics such as codeine relax the

LES, making it more likely for acid

to reflux back into

the esophagus.

Clip Art derived from

Microsoft Office


Slide62 l.jpg

Yes, You are correct! the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.

Narcotics such as codeine relax the

LES, making it more likely for acid

to reflux back into

the esophagus.

Clip Art derived from

Microsoft Office


Click on true or false63 l.jpg
Click on the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.True or False

The diaphragm helps to open

the esophagus.


Slide64 l.jpg

Sorry, you are incorrect. the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.

The diaphragm supports and puts

pressure on the sphincter to keep

it closed while swallowing.

Clip Art derived from

Microsoft Office


Slide65 l.jpg

Yes, You are correct! the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.

The diaphragm supports and puts

pressure on the sphincter to keep

it closed while swallowing.

Clip Art derived from

Microsoft Office


Click on true or false66 l.jpg
Click on the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.True or False

Saliva produces more acid,

creating a potential

for increased reflux.


Slide67 l.jpg

Sorry, you are incorrect the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.

Swallowed saliva helps neutralize

acid. It is one of the 3 mechanisms

that keeps acid out of the esophagus.

Clip Art derived from

Microsoft Office


Slide68 l.jpg

Yes, You are correct! the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.

Swallowed saliva helps neutralize

acid. It is one of the 3 mechanisms

that keeps acid out of the esophagus.

Clip Art derived from

Microsoft Office


Inflammation and its impact l.jpg
Inflammation and its impact the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.

Often the suffix of “itis” leads the reader

to know there is inflammation.

Therefore, inflammation caused by

GERD is called, “esophagitis”.

Clip Art derived from

Microsoft Office


Slide70 l.jpg

Inflammation is the body’s response, as the neck, chest, & throat area. This can be confused with other diseases, even a heart attack.

a protective measure against

infection and injury.

Repeated exposure to acid in the

esophagus will cause inflammation

and injury to the mucosa.


Slide71 l.jpg

“Inflammation as a result of GERD can cause epithelial changes, marked by polymorphonuclear or mixed polymorphonuclear and round cell infiltration”.(Fennerty, 2003)

Clip Art derived from

Microsoft Office


There are 3 inflammatory processes that can occur with esophagitis l.jpg
There are 3 inflammatory changes, marked by polymorphonuclear or mixed polymorphonuclear and round cell infiltration”. processes that can occur with esophagitis:

  • Erosive Esophagitis

  • Esophageal Strictures

  • Barrett’s Esophagus – (Fennerty, 2003)


Erosive esophagitis l.jpg
Erosive Esophagitis changes, marked by polymorphonuclear or mixed polymorphonuclear and round cell infiltration”.

“Erosions appear in esophageal

mucosa as eroded endothelium”.

(Fennerty, 2003)


Contributing factors of erosive esophagitis l.jpg

Hiatal Hernia changes, marked by polymorphonuclear or mixed polymorphonuclear and round cell infiltration”.

Decreased pressure in the lower esophageal sphincter (LES)

Impaired ability of the tissue to resist injury

Impaired esophageal clearance

Increased volume of acid

(Fennerty, 2003)

Contributing factors of Erosive Esophagitis:


Slide75 l.jpg

People with erosive esophagitis changes, marked by polymorphonuclear or mixed polymorphonuclear and round cell infiltration”.

may have mild to severe

symptoms of pain. (Fennerty, 2003)

Clip Art derived from

Microsoft Office


Strictures l.jpg
Strictures changes, marked by polymorphonuclear or mixed polymorphonuclear and round cell infiltration”.

A stricture is a narrowing If

esophagitis is left untreated, scarring

can occur resulting in a

stricture that is irreversible .(Fennerty, 2003)


Contributing factors of esophageal strictures l.jpg
Contributing Factors of changes, marked by polymorphonuclear or mixed polymorphonuclear and round cell infiltration”. Esophageal Strictures

  • Decreased pressure in the lower esophageal sphincter (LES)

  • Hiatal Hernia

  • Ineffective peristalsis

    (Fennerty, 2003)


Slide78 l.jpg

People with strictures often feel like there is something stuck in their throat. Severe strictures result in difficulty swallowing (dysphagia).

(Fennerty,2003)

Clip Art derived from

Microsoft Office


Slide79 l.jpg

Those with severe strictures usually have less symptoms of heartburn, acid is not able to reflux due to the narrowing of the esophagus.(Fennerty, 2003)


Slide80 l.jpg

Those with strictures may also have weight loss, due to a change in their diet to accommodate the strictures.

(Fennerty, 2003)


Stress response l.jpg
Stress Response a change in their diet to accommodate the strictures.

Stress is a complex physiological

response to changes in

the environment.


Slide82 l.jpg

Prolonged stress has the a change in their diet to accommodate the strictures.

ability to decrease the immune system, making the body susceptible

to inflammation and infection. (Porth, 1998)


Slide83 l.jpg

In an effort to cope with the a change in their diet to accommodate the strictures.

disruption in routine, caused by

stress, unhealthy lifestyles

become evident.

Clip Art derived from

Microsoft Office


Pharmocogenomics l.jpg

There are 3 categories of medications that can help alleviate or prevent symptoms from occurring.

(Kaynard, Flora, 2001)

Antacids

H-2 receptor blockers

Proton pump inhibitors

Pharmocogenomics

Clip Art derived from

Microsoft Office


Antacids l.jpg

Maalox alleviate or prevent symptoms from occurring.

Mylanta

Tums

Rolaids

These medications help to neutralize stomach acid. They usually provide quick relief, however, will not heal any inflammation.

(CNN.Com)

Antacids


H 2 receptor blockers l.jpg

Tagamet alleviate or prevent symptoms from occurring.

Zantac

Pepcid AC

“These medications reduce the acid production. They do not act as quickly as antacids, but provide longer relief”. (CNN.Com) They start working in about 30 minutes.

H-2 Receptor Blockers


Proton pump inhibitors l.jpg

Prevacid alleviate or prevent symptoms from occurring.

Prilosec

Aciphex

Protonix

Nexium

These medications are long acting and block acid production. “Because of this, they have the ability to allow time for damaged tissue to heal from inflammation”.

(CNN.Com)

Proton Pump Inhibitors


Cell growth and death l.jpg
Cell Growth and Death alleviate or prevent symptoms from occurring.

As mentioned earlier, as a result of

inflammation:

cellular changes can occur.


Slide89 l.jpg

These cellular changes can be alleviate or prevent symptoms from occurring.

a precursor to cancer. (Fennerty, 2003)

Clip Art derived from

Microsoft Office


Slide90 l.jpg

Some articles may refer to these changes as “metaplasia”. This is the actual transformation of cells or tissue from normal to abnormal; whereas, “dysplasia” is the growth of abnormal

cells or tissue. (Porth, 1998)


Barrett s esophagus is the outcome of these cellular changes l.jpg
Barrett’s Esophagus is the outcome of these cellular changes.

Cells in the lining of the esophagus are actually replaced with abnormal cells similar to those in the stomach.

(Fennerty, 2003)


Slide92 l.jpg

This would be, “metaplasia”. As changes.

the cells replicate to multiply,

dysplasia is occurring. (Porth, 1998)


Slide93 l.jpg

The exact mechanism is not known. changes.

However, these cellular changes

are believed to be a protective

response to adapt to the repeated

inflammation of exposure to

stomach acid. (MedicineNet.com)

.


Slide94 l.jpg

Ulcers, although not a common symptom, can be found with Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding. (Fennerty, 2003)


Click on true or false95 l.jpg
Click on Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding. True or False

Some people with strictures have

decreased symptoms of reflux.


Slide96 l.jpg

Sorry, you are incorrect. Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding.

A stricture is a narrowing, as a

result, the acid is sometimes

unable to reflux.


Slide97 l.jpg

Yes, You are correct! Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding.

A stricture is a narrowing, as a

result, the acid is sometimes

unable to reflux.


Click on true or false98 l.jpg
Click on Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding. True or False

If esophagitis is left untreated,

scarring can occur resulting in a

stricture, which eventually

heals itself.


Slide99 l.jpg

Sorry, you are incorrect. Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding.

Once scarring is present, the

stricture is irreversible.


Slide100 l.jpg

Yes, You are correct! Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding.

Once scarring is present, the

stricture is irreversible.


Click on true or false101 l.jpg
Click on Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding. True or False

GI bleeding is one of the symptoms

of Barrett’s Esophagus.


Slide102 l.jpg

Sorry, you are incorrect. Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding.

GI bleeding can be a symptom

of an ulcer, which can be

present in someone with Barrett’s

Esophagus, although not common.


Slide103 l.jpg

Yes, You are correct! Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding.

Gi bleeding can be a symptom

of an ulcer, which can be

present in someone with Barrett’s

Esophagus, although not common.


Click on true or false104 l.jpg
Click on Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding. True or False

Maalox or mylanta will help

prevent episodes of

acid reflux.


Slide105 l.jpg

Sorry, you are incorrect. Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding.

Maalox and mylanta are anatacids,

which provide quick relief, but will

not prevent acid reflux.


Slide106 l.jpg

Yes, You are correct! Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding.

Maalox and mylanta are antacids,

which provide quick relief, but will

not prevent acid reflux.


Click on true or false107 l.jpg
Click on Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding. True or False

Proton Pump Inhibitors allow time

for damaged tissue to heal by

blocking acid production.


Slide108 l.jpg

Sorry, you are incorrect. Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding.

Proton Pump Inhibitors allow time

for damaged tissue to heal by

blocking acid production.


Slide109 l.jpg

Yes, You are correct! Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding.

Proton Pump Inhibitors allow time

for damaged tissue to heal by

blocking acid production.


Click on the flowers below for a summarized outline l.jpg
Click on the flowers below for Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding. a summarized outline

Clip Art derived from

Microsoft Office


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Acknowledgements Barrett’s Esophagus. The ulcers can lead to Gastrointestinal bleeding.

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Clip Art derived from

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