GERD

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WHAT IS GERD

Gastro-esophageal reflux disease is a digestive disorder that affects the lower esophageal sphincter which causes flow of gastric contents back into the oesophagus. Approximately 50% of population suffer from this disease; it may range from mild intermittent to more severe.

CAUSES

Drugs such as Tetracycline, iron supplements, quinidine, aspirin, Ibuprofen, K+ supplements, anticholinergic, benzodiazepines.. The list is endless

·        Hiatal hernia

·        Abdominal pressure( pregnancy obesity)

·        Vagus nerve stimulation

·        Food consumption such as caffeine, spicy or fried food peppermint, chocolate.

·        Lifestyle ( alcohol, smoking)

·        Pyloric stenisis

CLINICAL MANIFESTATIONS

·        Pyrosis ( heart burn, burning sensation of the chest

·        Regurgitation

·        Hypersalivation

·        Nausea

·        Chest pain

·        Esophagitis

·        Coughing

·         Dyspepsia (Indigestion)

 DIAGNOSTIC FINDINGS

·        Endoscopy

·        Barium swallow.

·         Ambulatory 12-36hour esophageal PH monitoring

·        Bilirubin monitoring ( To measure bile reflux pattern)

 PATHOPHYSIOLOGY

Normally Lower esophageal sphincter (LES) creates enough pressure around d lower end of d esophagus to close it, so that gastric contents don't flow back to d esophagus.

Reflux occurs when Lower esophageal sphincter pressure is deficient or d pressure of d stomach exceeds Lower esophageal sphincter pressure.

 When this happens, lower esophageal sphincter relaxes and allows for reflux of stomach contents into the esophagus.

 The acidity of gastric contents and amount of time in contact with esophageal mucosa re related to d degree of mucosa damage.

 Esophageal ulcer and esophagitis may result.

 MEDICAL MANAGEMENT

Health Education

Low fat diet

Avoid caffeine, tobacco, beer, milk, foods containing peppermint and carbonated drinks.

Avoid eating or drinking 2 he's before bed time

Elevate d head of bed to 15-30°

Maintain body weight.

Medications

Antacids or H2 receptor antagonist (fanotidine, ranitidine)

Proton pump inhibitors (lanzoprazole, omeprazole, rabeprazole)

Prokinetic agents (Bethanecol, dompridone, metoclopramide)

Surgical management

Nissen fundoplication (wrapping of a portion of the stomach fundus around the sphincter area of the esophagus)

NURSING MANAGEMENT

ASSESSMENT: History taking, collection of subjective and objective data.

RELIEVING OF PAIN:

·        Administer prescribed medications.

·        The patient is advised to avoid any activity that increase pain

·        Patient is advised to remain upright after each meal for about 20-30mins to prevent reflux.

DIET

·        Patient should be encouraged to eat slowly and to chew slowly,so all foods can pass easily to d stomach.

·        Small frequent feeding of non irritating foods are recommended

Health Education

·        Teach d patient to elevate d height of bed  while in bed

·        Encourage patient not to eat or drink 2 hours before bed time

·        Teach  patient  to avoid foods that can cause pain or that can increase acid  secretion.

·        Teach patient to avoid smoking, drinking, taking caffeine and carbonated drinks.

NURSING DIAGNOSIS

Ø Impaired tissue integrity related to esophageal exposure to gastric acid evidenced by  burning sensation of d chest

Ø Acute pain related to tissue exposed to gastric contents evidenced by patient's verbalisation.

Ø Imbalanced Nutrition: Less than bday requirements related to inability to intake enough foods because of reflux evidenced by weight loss

Ø Deficient knowledge related to lack of information regarding condition evidenced by patient's asking too many questions.

Ø Risk for Aspiration related to impaired swallowing.

COMPLICATIONS

Ø Esophagitis

Ø Barrett's esophagus

Ø Esophageal cancer

Ø Aspiration pneumonia

Ø Laryngitis

CONCLUSION

GERD is an excessive reflux, may occur because of an incompetent lower esophageal sphincter, pyloric stenosis, or a motility disorder.