Gastroesophageal Reflux Disease (GERD)

Question 1

Gastroesophageal Reflux Disease (GERD)

Answer 1

• common condition characterized by gastric content and enzyme leakage into the esophagus
• corrosive fluids irritate the esophageal tissue and limits its ability to clear the esophagus

Question 2

Health Promotion and Prevention of GERD

Answer 2

1) maintain BMI below 30
2) stop smoking
3) drink alcohol in moderation

Question 3

Risk Factors for GERD

Answer 3

1) obesity
2) older age
3) sleep apnea

Question 4

Contributing Factors

Answer 4

• excessive ingestion of foods that relax the lower esophageal sphincter (LES)–fatty foods and fried foods, chocolate, caffeinated beverages, and alcohol
• increased abdominal pressure due to obesity, pregnancy, bending at the waste, ascites, or tight clothing
• drugs that relax the LES (theophylline, nitrates, calcium channel blockers, anticholinergics, diazepam)
• drugs (NSAIDs) or events (stress) that increase gastric acid
• hiatal hernia
• lying flat
• smoking

Question 5

Manifestations of GERD

Answer 5

1) frequent and prolonged substernal heartburn (dyspepsia) and regurgitation (acid reflux)
2) throat irritation (chronic cough, laryngitis), hypersalivation, eructation, flatulence, bitter taste in mouth, or atypical chest pain from esophageal spasm
3) chronic GERD can lead to dysphagia (difficulty swallowing)
4) GERD may mimic a heart attack due to the substernal pain that can radiate to jaw and back

Question 6

Diagnostic Procedures

Answer 6

1) esophagogastroduodenoscopy (EGD)
- allows visualization of esophagus.
- may reveal esophagitis or Barrett’s epithelium (premalignant cells)
- done using moderate sedation to observe for tissue damage (in 60% of client with GERD) and possibly to dilate structures
2) verify gag response is returned prior to providing oral fluids or food following the procedure
3) 24 hr ambulatory esophageal pH monitoring
- small catheter placed through nose and into distal esophagus where pH readings are taken in relation to food, position, and activity
4) esophageal manometry
- records lower esophageal sphincter pressure
5) barium swallow
- can identify a hiatal hernia, which would contribute to or cause GERD

Question 7

Medications Used in Treatment of GERD

Answer 7

1) antacids–aluminum hydroxide (Mylanta) neutralizes excess acid
- instruct client to take when acid secretion is highest (1-3 hr after eating and at bedtime) and separate from other medications by at least 1 hr
2) histamine2 receptor antagonists–ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid) reduce secretion of acid
3) proton pump inhibitors (PPIs)–pantoprazole (Protonix), esomeprazole (Nexium), and lansoprazole (Prevacid)–reduce gastric acid by inhibiting the cellular pump necessary for secretion
4) prokinetics–metoclopramide hydrochloride (Reglan)–increase motility of the esophagus and stomach
- monitor client for extrapyramidal side effects

Question 8

Therapeutic Procedures

Answer 8

1) stretta procedure
- uses radiofrequency energy, applied by an endoscope, to the LES muscle
- causes the tissue to contract and tighten
2) fundoplication
- surgical option may be indicated for clients who fail to respond to other treatments
- fundus of stomach is wrapped around and behind esophagus to create physical barrier

Question 9

Client Education

Answer 9

1) avoid offending foods
2) avoid large meals
3) remain upright after eating
4) avoid eating before bed
5) avoid tight-fitting clothing around the middle
6) lose weight, if applicable
7) elevate the head of bed 6-8 inches with blocks
8) sleep on the right side

Question 10

Complications of GERD

Answer 10

1) aspiration of gastric secretion
- reflux of gastric fluids into the esophagus can be aspirated into trachea
2) risks associated with aspiration:
- asthma exacerbations
- frequent upper respiratory, sinus, or ear infections
- aspiration pneumonia
- Barrett’s epithelium (premalignant) and esophageal adenocarcinoma