Mr. Sankappa Definition Gastro esophageal reflux disease is a chronic and relapsing condition in which prolonged reflux of hydrochloric acid, pepsin and bile salts in the esophagus, oral cavity and respiratory system occurs that leads to esophagitis Excessive intake of junk foods, coffee, chocolate Excessive intake of onion, tomato, and beverages Heavy exercise Alcoholic and smoking Medications Heartburn Discomfort Chest pain Difficulty in respiration Aspiration pneumonia After endoscopy the lesions are graded for severity using the Savary Miller grading system; Grade 1: single or multiple erosions on a single fold. Grade 2: multiple erosions affecting multiple folds. Erosions may be confluent. Grade 3: multiple circumferential or rounded erosions. Grade 4: ulcer, stenosis or esophageal shortening. Grade 5: Barrett's epithelium. Columnar metaplasia (cellular changes on the microscopic level) in the form of circular or non-circular (islands or tongues) extensions. Pathophysiology Management Antacids: An antacid is a substance which neutralizes stomach acidity, used to relieve heartburn, indigestion or an upset stomach (ex: Rantac, Zantac) H2receptor antagonist: H2 antagonists block histamine-induced gastric acid secretion from the parietal cells of the gastric mucosa. They include cimetidine, famotidine, nizatidine  Proton Pump Inhibitors: Proton pump inhibitors (PPIs) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid (Omeprazole, Rabeprazole, pantoprazole) Cholinergic drugs:Cholinergic drug, any of various drugs that inhibit, enhance, or mimic the action of the neurotransmitter (acetylcholine, carbachol, methacholine) Cytoprotective drugs: is a process by which chemical compounds provide protection to cells against harmful agents (carbenoxolone, sucralfate,  misoprostol)  Prokinetic drugs: prokinetic, is a type of drug which enhances gastrointestinal motility by increasing the frequency of contractions in the small intestine or making them stronger, but without disrupting their rhythm. (Benzamide, Cisapride, Domperidone). Endoscopic intraluminal valvuloplasty Gastric tissue is utilised to increase the integrity of LES By creating a valve like structure.

2. Definition
• Gastro esophageal reflux disease is a chronic
and relapsing condition in which prolonged
reflux of hydrochloric acid, pepsin and bile
salts in esophagus, oral cavity and respiratory
system occurs that leads to esophagitis

4. Excessive intake of junk foods, coffee, chocolate

5. Excessive intake of onion, tomato, and beverages

6. • Heavy exercise
Alcoholic and smoking

7. Medications

11. • Heart burn
• Discomport
• Chest pain
• Difficulty in respiration
• Aspiration pneumonia

12. After endoscopy the lesions are graded for
severity using the Savary Miller grading system;
• Grade 1: single or multiple erosions on a single fold.
• Grade 2: multiple erosions affecting multiple folds. Erosions
may be confluent.
• Grade 3: multiple circumferential or rounded erosions.
• Grade 4: ulcer, stenosis or esophageal shortening.
• Grade 5: Barrett's epithelium. Columnar metaplasia (cellular
changes on the miscroscopic level) in the form of circular or
non-circular (islands or tongues) extensions.

13. Pathophysiology
GERD
Inflammation of esophagus
Esophageal irritation and erosion of mucus lining
The acidic gastric secretion reflux up into esophagus
Increased the pressure in the abdomen
Decreased gastric emptying, hyper secretion of stomach
content
Due to etiological factors

15. Management

16. • Antacids : An antacid is a substance which
neutralizes stomach acidity, used to relieve
heartburn, indigestion or an upset stomach (ex:
Rantac, Zantac)
• H2receptor antagonist: H2 antagonists block
histamine-induced gastric acid secretion from the
parietal cells of the gastric mucosa. They include
cimetidine, famotidine, nizatidine

17. • Photon Pump Inhibitors: Proton pump
inhibitors (PPIs) reduce the production of acid by
blocking the enzyme in the wall of the stomach
that produces acid (Omeprazole, Rabeprazole,
pantaprazole)
• Cholinergic drugs:Cholinergic drug, any of various
drugs that inhibit, enhance, or mimic the action of
the neurotransmitter (acetylcholine, carbachol,
methacholine)

18. • Cytoprotective drugs: is a process by which
chemical compounds provide protection to cells
against harmful agents (carbenoxolone,
sucralfate, misoprostol)
• Prokinetic drugs: prokinetic, is a type of drug
which enhances gastrointestinal motility by
increasing the frequency of contractions in the
small intestine or making them stronger, but
without disrupting their rhythm. (Benzamide,
Cisapride, Domperidone).

20. Endoscopic intraluminal valvuloplasty
• Gastric tissue is utilised to increase the
integrity of LES By creating a valve like
structure.

21. Endoscopic radiofrequency therapy

23. A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via
laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease
(GERD) and hiatal hernia.

25. • Gastric bypass surgery makes the stomach
smaller and allows food to bypass part of the
small intestine.

27. Nursing management
• ACUTE PAIN AT EPIGASTRIC REGION RELATED TO REFLUX OF
THE GASTRIC CONTENTS INTO THE ESOPHAGUS
• NAUSEA RELATED TO GLOBUS SENSATION, REGURGITATION,
DELAYED ESOPHAGEAL EMPTYING.
• IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENT
RELATED TO NAUSEA, INABILITY TO INTAKE FOOD
ADEQUATELY SECONDARY TO GLOBUS SENSATION IN
THROAT, PYROSIS.

28. • HEMORRHAGE RELATED TO ERODED MUCOSAL TISSUE
OF ESOPHAGUS.
• INEFFECTIVE THERAPEUTIC REGIMEN RELATED TO LACK
OF KNOWLEDGE OF LONG-TERM MANAGEMENT OF
GERD, LIFESTYLE MODIFICATION, APPROAPRIATE DIET
THERAPY

29. Complication
• Chronic erosive Oesophagitis: It is responsible
for 40-60% of GERD symptoms.
• Esophageal stricture: It is the result of healing
of erosive esophagitis.
• Barrett’s esophagus: It accounts for 8-15% of
all GERD cases.

30. Esophageal stricture
• Benign esophageal stricture describes a narrowing or
tightening of the esophagus. The esophagus is the tube
that brings food and liquids from your mouth to your
stomach. “Benign” means it’s not cancerous.
• Benign esophageal stricture typically occurs when
stomach acid and other irritants damage the lining of the
esophagus over time. This leads to inflammation
(esophagitis) and scar tissue, which causes the
esophagus to narrow.

31. Clinical manifestation
• Difficult or painful swallowing
• Unintended weight loss
• Regurgitation of food or liquids
• Sensation of something stuck in the chest
After you eat
• Frequent burping or hiccups
• Heartburn

32. Management
• Esophageal dilation
• Esophageal dilation, or stretching, is the
preferred option in most cases. Esophageal
dilation can cause some discomfort, so you’ll
be under general or moderate sedation during
the procedure.

33. • Esophageal stent placement
• The insertion of esophageal stents can provide
relief from esophageal stricture. A stent is a thin
tube made of plastic, expandable metal, or a
flexible mesh material. Esophageal stents can
help keep a blocked esophagus open so you can
swallow food and liquids.

34. • Diet & lifestyle
• Making certain adjustments to your diet and
lifestyle can effectively manage GERD, which is
the primary cause of benign esophageal
stricture.

35. Barrette's esophagus
Barrett’s esophagus is a condition in which the lining of the
esophageal mucosa is altered. It typically occurs in
association with GERD; indeed, longstanding untreated
GERD may lead to Barrett’s esophagus. Reflux eventually
causes changes in the cells lining the lower esophagus.
The cells that are laid to cover the exposed area are no
longer squamous in origin. These precancerous cells
initiate the healing process and can be a precursor to
esophageal cancer.

36. Management
• Monitoring varies depending on the extent of cell
changes. Follow-up endoscopy is performed within 6
months if there are minor cell changes. Treatment is
individualized for each patient. The options include
intensive surveillance with
• Biopsies,
• Endoscopic ablation therapy (eg, photodynamic
therapy),
• Esophagectomy