GASTROESOPHAGEAL REFLUX DISEASE NURSING NOTE

1. GASTROESOPHAGEAL
REFLUX DISEASE
(GERD)
JAISON THOMAS DANIEL
NURSING TUTOR
YFCON, RATNAGIRI

2. GERD
• GERD is a chronic condition where gastric contents flowing back to the esophagus due
to weak or damaged Lower Esophageal Sphincter (LES).
• It is also known as Acid Reflux Disease.
• Gastroesophageal reflux disease occurs when the amount of gastric juice that refluxes
into the esophagus exceeds the normal limit, causing symptoms with or without
associated esophageal mucosal injury ie, esophagitis.

3. ETIOLOGY
Impaired LES mechanism
• Hiatal hernia, pregnancy, obesity, overeating, tight fitting dress.
• Medications: antihistamines, calcium channel blockers, antidepressants, sedatives,
smoking
Delayed gastric emptying
• Anticholinergics can delay gastric emptying
A gastric outflow obstructions
Decreased esophageal motility

6. DIETARY RISK FACTORS
• Black pepper, garlic, raw onions, and other spicy foods.
• Chocolate.
• High fatty food.
• Citrus fruits and products, such as lemons, oranges and orange juice.
• Coffee and caffeinated drinks, including tea and soda
• Tobacco smoking.

7. CLINICAL MANIFESTATIONS
Typical esophageal symptoms include the
following:
• Heartburn
• Epigastric pain
• Regurgitation
• Dysphagia
• Waterbrash
• Nausea
• Odynophagia
• Belching
Extraesophageal symptoms,
• Coughing and/or wheezing
• Hoarseness, sore throat
• Otitis media
• Noncardiac chest pain
• Enamel erosion or other dental
manifestations

8. COMPLICATIONS OF GERD
• Inflammation of the esophagus (increased risk of cancer from the chronic inflammation)
• Narrowing of the esophagus: strictures
• Lung problems: asthma, pneumonia, voice changes, wheezing, fluid in the lungs
• Barrett’s esophagus: lining of the esophagus is replaced with similar lining that makes
up the intestinal lining which increase risk of cancer.

9. DIAGNOSTIC EVALUATIONS
• History collection
• Physical Examinations
• Upper gastrointestinal endoscopy/esophagogastroduodenoscopy
• Esophageal manometry
• Ambulatory 24-hour pH monitoring

10. MANAGEMENET
• The goals are to
control symptoms
to heal esophagitis
to prevent recurrent esophagitis or other complications.
• The treatment is based on lifestyle modifications and control of gastric acid secretion
through medical therapy with antacids or proton pump inhibitors or surgical treatment
with corrective antireflux surgery.

11. LIFE STYLE MODIFICATION
• Losing weight (if overweight)
• Avoiding alcohol, chocolate, citrus juice, and tomato-based products
• Avoiding peppermint, coffee, and possibly the onion family
• Eating small, frequent meals rather than large meals
• Waiting 3 hours after a meal to lie down
• Refraining from ingesting food (except liquids) within 3 hours of bedtime
• Elevating the head of the bed by 8 inches
• Avoiding bending or stooping positions
• Cessation of smoking.

12. PHARMACOLOGICAL MANAGEMENT
H2 receptor antagonists
• These are the first-line agents for patients with mild to moderate symptoms and grades
I-II esophagitis.
• It block histamine. When histamine is released it causes the parietal cells to release
HCL but this response will be blocked so gastric acid secretion will be decreased.
• Ranitidine ,Cimetidine, Famotidine, Nizatidine.

13. PHARMACOLOGICAL MANAGEMENT
Proton Pump Inhibitors
• Attaches to the “proton pump” on the parietal cells which is the hydrogen/potassium (H+,
K+) ATPase enzyme and blocks the release of hydrogen ions. These ions would mixed
with the chloride ions and form gastric acid but this is blocked so there is a decrease in
gastric acid.
• Omeprazole, Lansoprazole, Rabeprazole, Esomeprazole.

14. PHARMACOLOGICAL MANAGEMENT
Prokinetics
• Prokinetics improve the motility of the esophagus and stomach and increase the lower
esophageal sphincter (LES) pressure to help reduce reflux of gastric contents. They also
accelerate gastric emptying.
• Metoclopramide, Bethanechol.

15. PHARMACOLOGICAL MANAGEMENT
Antacids
• It neutralizes acid. It increases gastric pH to greater than 4 and inhibits the proteolytic
activity of pepsin, reducing acid indigestion. Antacids can initially be used in mild cases.
• Magnesium Hydroxide, Magnesium hydroxide.

16. SURGICAL MANAGEMENT
• Nissen fundoplication
• The gastric fundus (upper part) of
the stomach is wrapped around the lower
end of the esophagus and stitched in
place, reinforcing the closing function of
the lower esophageal sphincter.