This document discusses gastroesophageal reflux disease (GERD). It begins with the anatomy and physiology of the esophagus and definitions of GERD. It then explains that GERD occurs when the lower esophageal sphincter is deficient, allowing gastric contents to back up into the esophagus. Symptoms include pyrosis, dyspepsia, regurgitation, and pain on swallowing. Diagnostic tests include endoscopy, barium swallow, and pH monitoring. Management involves lifestyle changes like diet modification and elevation of the head of the bed, medications like antacids, H2 blockers, and PPIs, and potentially surgery. Nurses play a role in educating patients, monitoring

1. Abdelrahman Alkilani, RN, BSN
Gastro-Esophageal
Reflux Disease

2. Overview
 Anatomy and physiology
 Definition of GERD
 Phathophysiology
 Clinical manifistations
 Diagnostic tests
 Medical management
 Nursing management

3. Anatomy and physiology
 Esophagus
 Mucus-lined, muscular tube that carries food from the
mouth to stomach.
 Begins at the base of the pharynx and ends about
4cm below the diaphragm.
 Its ability to transport food and fluid is facilitated by
the upper esophageal sphincter (hypophrengeal) and
the lower esophageal sphincter (gastroesophageal).
 There is no serosal layer of the esophagus.

4. GERD
 Some degree of esophageal reflux (back-
flow of gastric and dudenal contents into
the esophagus) is normal in both adults
and children.
 GERD is the excessive reflux.

5. Pathophysiology
 Normally, Lower Esophageal Sphincter (LES)
creates enough pressure around the lower end
of the esophagus to close it. So, gastric content
don’t back up into the esophagus.
 Reflux occurs when LES pressure is deficient or
the pressure of the stomach exceed LES
pressure
 When this happens, the LSE relaxes.

6. Pathophysiology
 Common causes
Incompetent lower esophageal sphincter
Pyloric stenosis
Motility disorder

7. Pathophysiology
The acidity of gastric content and amount of
time in contact with esophageal mucosa
are related to the degree of mucosal
damage.
 Esophageal ulcer and esophagitis may
result

8. Clinical Manifestations
 Pyrosis (Burning sensation in the esophagus).
 Dyspepsia (indigestion).
 Regurgitation.
 Dysphagia or odynophagia (pain on swallowing)
 Hypersalivation.
 Esophagitis.

9. Assessment and Diagnostic
findings
 Endoscopy

10. Assessment and Diagnostic
findings
 Barium swallow
To evaluate the damage
to the esophgeal
mucosa.

11. Assessment and Diagnostic
findings
 Ambulatory 12- to 36-hour
esophageal pH monitoring
 to evaluate the degree of acid reflux

12. Assessment and Diagnostic
findings
 Bilirubin monitoring (bilitec)
To measure bile reflux patterns

13. Medical Management
 Health Education
Diet
 Low fat diet
 Avoid caffeine, tobacco, beer, milk, foods
containing peppermint or spearmint, and
carbonated beverage.
Avoid eating or drinking 2 hours before bed
time.

14. Medical Management
 Health Education
Maintain body weight.
Avoid tight-fitting clothes.
Elevate the head of the bed on 15-20cm
blocks.
Elevate the upper body on pillow.

15. Medical Management
 Medications
Antacids or H2 receptor antagonist.
 famotidine, nizatidine, or rantidine
Proton pump inhibitors
 Lanzoprazole, esomeprazole, or rabeprazole.
Prokinetic agents
 Bethanecol, dompridone, and meetoclopramide.

16. Medical Management
 Surgical intervention
Nissen fundoplication
(wrapping of a portion of the gastric fundus around the
sphincter area of esophagus)

17. Nursing management
Assessment Nursing
diagnosis
Objective Intervention evaluation
Pt complains
of pyrosis
Impaired
tissue
integrity R/
T
esophageal
exposure to
gastric acid
- Pt not to
have pyrosis
for after 8 hrs.
- Pt is able to
verbalize
knowledge of
necessity
lifestyle
changes with
24 hours of
discharge
from the
hospital
Teach
patient to
avoid foods
that cause
pain and or
can
increase
acid
secretion.
-Pt has no
more
pyrosis
-Pt knows
the
necessity
lifestyle
changes

18. Nursing management
Assessment Nursing
diagnosis
Objective Intervention evaluation
- Pt complains
of recurrent
regurgitation
- Pt shows
signs of
uncomforting.
Risk of
aspiration
R/T
recurrent
regurgitation
Pt won’t
show signs
of aspiration
within 8
hours
Teach the pt
to:
-Elevate the
HOB while
in bed
-Eat small
frequent
meals.
-Not to eat
or drink 2
hours
before bed
time
-No more
regurgitation
s, according
to the pt

19. Nursing management
Assessment Nursing
diagnosis
Objective Intervention evaluation
- Pt complains
of pain 8 on
scale
-Pt shows
signs of
uncomfort
Acute pain
R/T tissue
exposed to
gastric
content
Pain will be
relieved
within 8
hours
-Assure that
pt is taking
his
medication
on time
Teach
patient to
avoid foods
that cause
pain and or
can
increase
acid
secretion
- Pain score
became 2
out of 10

20. Nursing management
Assessment Nursing
diagnosis
Objective Intervention evaluation
-Pt has weight
loss
-Pt state that
he is not
eating so he’ll
not feel
pyrosis.
Imbalance
nutrition R/T
decrease
intake
Pt will
achieve
adequate
caloric and
nutritional
intake
-Explain the
importance
of adequate
nutrition
-Teach the
pt about the
diet which
doesn’t
cause
esophagus
irritation
-No more
weigh loss
during the
daily
weighting
-Pt receiving
and
adequate
caloric diet
as followed
by Dietitian

21. Summary
 GERD is an excessive reflux may occur because
of a incompetent lower esophageal sphincter,
pyloric stenosis, or a motility disorder.
 symptoms may include pyrosis, dyspepsia,
regurgitation.
 Management starts with health education, then
medications, and the last option will be the
surgical interventions
 Nurses play a significant role in providing care
for patients with GERD.

22. Assignment
 Write about a diet plan for patient with
GERD. What are the recommended food
for them and which types of food should
be avoided.
Date of submission, Monday 12th
Oct, 2015.

23. Reference
 Brunner & Suddarth’s Textbook of
Medical-Surgical Nursing, 2013.

24. Thanks