For 2nd year B.Sc Nursing students

1. Gastro - Esophageal Reflux
Disease (GERD)
Presented By:
Mr. Nandish. S
Asso. Professor
Mandya Institute of Nursing
Sciences

2. Definition :
 GERD is not a disease, but a syndrome.
 It is a condition in which acid containing contents in your
stomach persistently leak back up into lower esophagus,
that leads to significant symptomatic conditions or
histopathologic alterations.

4. Incidence & prevalence:
- Approximately 5 to 7 % of the world’s population is
experiencing GERD.
- Around 17.5 population experience daily symptoms.
- More than 60 million Americans experience periodic
symptoms of GERD.
- More than 10 million cases are reporting in India.

5. Etiology :
 It results when the defence of Lower Esophageal
Sphincter are overwhelmed by reflux of stomach acidic
contents.
 Hiatal Hernia.
 Incompetent Lower Esophageal Sphincter.
 Decreased Esophageal Clearance due to impaired
esophageal motility.
 Decreased gastric emptying.

6. Risk Factors:
 Obesity
 Pregnancy
 Connective tissue disorder (Scleroderma)
Aggravating Factors:
 Smoking
 Eating late night
 Eating large meals / fried / fatty foods
 Drinking beverages ( Alcohol, Coffee)

7. Pathophysiology :
Due to etiological factors
Pressure in the distal portion of esophagus decreases.
Gastric contents move from the region of higher
pressure to lower pressure (stomach to esophagus).
Esophageal irritation and inflammation
symptoms depends on presence of gastric enzymes
and bile salts in the regurgitated contents

8. Clinical Manifestations :
- Heart burn (Pyrosis) : It is a burning, tight sensation that is felt
intermittently beneath the lower sternum and spreads upward to the
throat and Jaw. It usually occurs after the meal.
- Trouble breathing.
- Hard swallowing / difficulty in swallowing.
- Nausea & vomiting.
- A feel of lump in the throat / Choking.
- Hoarseness & sore throat.
- Regurgitation : a hot , bitter or sour liquid coming into throat or
mouth.
- Postmeal bloating.

9. Complications :
- Esophagitis (inflammation of esophagus)
- Esophageal stricture
- Barrett’s esophagus : it is precancerous lesion /
esophageal metaplasia.
- Laryngitis / Laryngospasm
- Sleep problems

10. Diagnostic Studies :
• History collection & Physical examination
• Upper GI Endoscopy with biopsy
• Barium meal / swallow X-ray
• Radionuclide tests
• Esophageal manometry / motility studies
• pH studies

11. Treatment :
It is done by :
- Lifestyle modifications
- Nutritional therapy
- Drug therapy
- Surgical therapy
- Nursing management

12. Life style modifications :
- Avoid smoking
- Prevent aggravating factors
- Elevation of head of bed
- Pay attention to the factors that affect acid secretion and
gastric emptying.

13. Nutritional therapy :
- No specific diet is adviced.
- Avoid high fatty foods.
- Avoid chocolate, peppermint, coffee and tea.
- Avoid milk products especially at bed time.
- Encourage to consume more fluids.
- Avoid late evening meals & nocturnal snacks.
- Restrict tomato based products & orange juice (irritate
esophageal mucosa).

14. Drug therapy :
- Antacids : give quick relief of heatburn
- Anti secretory agents :
• H2 receptor blockers : cimetidine , Ranitidine
• Proton pump inhibitors : pantoprazole
- Anti ulcer agents : sucralfate
- Cholinergic drugs : urecholine
- Prokinetic drugs : metoclopramide (motility
enhancing agents).

15. Surgical Therapy :
- Antireflux surgery (increase integrity of LES)
- Nissen fundoplication (performed laproscopically which
reduces complications)
- Toupet fundoplication
- Endoscopic therapy : use Stretta device, which is a
balloon tipped four needle catheter that delivers
radiofrequency energy to smooth muscle of
gastroesophageal junction.

16. Nursing Management :
?

17. THANK YOU