Gastroesophageal reflux disease (GERD) is caused by conditions that affect the lower esophageal sphincter's ability to close tightly, allowing gastric secretions to reflux into the esophagus. Symptoms include heartburn, indigestion, and difficulty swallowing. Diagnosis involves endoscopy or barium swallow to evaluate esophageal damage. Treatment consists of lifestyle changes like diet modification and elevation of the head as well as medications like antacids, H2 blockers, proton pump inhibitors, and in severe cases, fundoplication surgery. Complications can include esophagitis, Barrett's esophagus, and respiratory issues from aspiration.

1. OBODHO

2. GASTROESOPHAGEAL REFLUX DISEASE
• A condition in which gastric secretions reflux into the esophagus ( stomach contents gets
back up into the esophagus).
• Some gastro-esophageal reflux is normal in both adults and children
• Excess reflux may occur because of:
• Incompetent lower esophageal sphincter
• Pyloric stenosis (narrowing of the opening from the stomach to the first part of the small
intestine (the pylorus))
• Motility disorder
Pathophysiology
• GERD is caused primarily by conditions that affect the ability of the lower esophageal
sphincter to close tightly, such as hiatal hernia ( occurs when the upper part of your
stomach bulges through the large muscle separating your abdomen and chest
(diaphragm).
• The esophagus damaged by acidic gastric secretions and exposure to digestive enzymes.

5. CLINICAL MANIFESTATION
• Pyrosis (burning sensation in esophagus)
• Dyspepsia (indigestion)
• Regurgitation (expulsion of material from the pharynx, or oesophagus)
• Dysphagia (swallowing difficulties)
• Odynophagia (pain on swallowing)
• Hyper-salivation
• Esophagitis
• Symptoms may mimic those of heart attack

6. ASSESSMENT AND DIAGNOSIS
• Endoscopy or barium swallow - to evaluate damage to the esophageal mucosa
• Ambulatory 12 -36 hours esophageal PH monitoring - to evaluate the degree of acid
reflux
• Bilirubin monitoring (Bilitec)-to measure bile reflux patterns which can cause mucosal
damage
• Guide : GERD often occurs in older people.

7. NURSING INTERVENTION
• First teach patient to avoid situations that decrease lower esophageal sphincter pressure
or esophageal irritation
• Eat low fat diet
• Avoid caffeine, tobacco, beer, milk, foods containing peppermint & carbonated
beverages (these triggers the condition)
• Avoid eating or drinking 2 hours before sleep
• Avoid tight fitting clothes
• Elevate upper body

8. MEDICAL INTERVENTION
• Prokinetic agents e.g. bethanicol, reglan & Motilium to accelerate gastric emptying
• If medication Mx is unsuccessful, surgical intervention may be necessary:
• Fundoplication- wrapping of a portion of the gastric fundus around the sphincter area of
the esophagus
• It can be performed by laparoscopy
• If reflux persists administer antacids or histamine receptor blockers
• Proton pump inhibitors e.g. prevacid to decrease gastric acid

9. MEDICAL INTERVENTION CONTD..
• Medications may include nonprescription antacids for mild symptoms (Tums,
Gaviscon).
• Histamine (H2) receptor antagonists used for mild to moderate symptoms
(cimetidine, famotidine, ranitidine , nizatidine ).
• Proton pump inhibitors (PPI) used for frequent, severe symptoms and Barrett’s
esophagus (esomeprazole , lansoprazole , omeprazole)

10. MEDICAL INTERVENTION CONTD..
• Prokinetic agents, not used as a first choice because of side effects,
(metoclopramide ) improve gastric emptying and function of the lower esophageal
sphincter .
• If surgery is necessary to alleviate symptoms, a fundoplication can be done.

11. COMPLICATIONS
• Esophagitis due to acid reflux.
• Over time this can lead to changes in the epithelium of the esophagus and lead to
Barrett’s esophagus(normal tissue lining the esophagus changes to tissue that
resembles the lining of the intestine)
• The patient with Barrett’s esophagus should have regular endoscopic
examinations.
• Respiratory complications such as bronchospasm, laryngospasm, and aspiration
pneumonia can also occur owing to aspiration of gastric contents.

12. REFERENCE
• Brunner and Suddarth’s textbook of medical surgical nursing 12th edition
• Herdman 2014