2. General Objective
•At the end of this session, students will be able
to explain about Gastroesophageal reflux
disease.
3. Specific Objectives:
•At the end of this session, students will be able
to:
•define gastro esophageal reflux disease.
•State the epidemiology of GERD.
•explain the etiology of GERD
•describe the etiopathogenesis of GERD
4. Contd…
•list the clinical manifestations of GERD
•explain the diagnostic evaluation of GERD
•state the management of GERD
•list the complications of GERD
•identify the prognosis of GERD
5. GASTROESOPHAGEAL REFLUX
DISEASE
Gastroesophageal reflux disease (GERD) is a fairly
common disorder marked by backflow of gastric or
duodenal contents into the esophagus that causes
troublesome symptoms and/or mucosal injury to
the esophagus
6.
7. Definition
• 'Symptoms or mucosal damage produced by the
abnormal reflux of gastric contents into the
esophagus.‘
(American College of Gastroenterology, ACG)
9. Epidemiology:
• Its one of the most common GI disorders, with a
prevalence of approximately 20% of adults in western
culture.
• Prevalence of GERD in the US is between 18.1 –
27.8%. However, the true prevalence of this disorder
could be higher because more individuals have access
to OTC acid reducing medications.
10. Contd…
•The prevalence of this disease is slightly higher
in men than women but prevalence of
symptoms is higher in woman than in men,
16.7% vs. 15.4%.
(article on GERD by Catiele Antunes and Abdul
Aleem , John Hopkins Hospital, July 8 2020.)
11. Contd…
•Over the last decade, there has been a
significant increase in the proportion of younger
patients with GERD, especially those within the
age range of 30-39 years.
( journal of neurogastroenterology and motility,
2018)
15. Contd…
•Motility disorders like scleroderma, esophageal spasm.
•Associated with aging in patients with irritable bowel
syndrome, COPD, cystic fibrosis etc..
•Also associated with tobacco use, smoking, alcohol
consumption, excessive coffee drinking, peptic ulcer
disease and gastric infection with H. Pylori
16. Contd.
• Any condition or position that increases intra-abdominal
pressure.
• The acidity of gastric content and amount of time in
contact with esophageal mucosa are related to the degree
of mucosal damage.
• Inflammation and ulceration of the esophagus may result,
causing esophagitis
17. Etiopathogenesis
Lower esophageal sphincter incompetence, transient lower esophageal sphincter relaxation
and hiatus hernia.
Normal antireflux barrier between the stomach and esophagus is impaired, either transiently
and permanently.
Offensive factors in the gastro duodenal contents, such as acid, pepsin, bile acids and trypsin
reflux in esophagus.
Develop symptoms of GERD (retrosternal burning discomfort, and acid regurgitation).
18. Clinical manifestations
• Pyrosis (burning sensation in the esophagus) :
1-2 hours after eating. Heartburn, defined as a
retrosternal burning discomfort and acid regurgitation.
Symptoms often occur after meals and may increase
when a patient is recumbent.
19. Contd…
•Dyspepsia (indigestion).
•Dysphagia or odynophagia (difficulty swallowing or
pain on swallowing)
•Nocturnal hypersalivation: release of salty secretions
in the mouth. This may cause coughing and chocking
while sleeping.
•Globus (sensation of something in throat).
•Symptoms may mimic those of the MI
25. Contd…
• Esophagogastroduodenoscopy (EGD)
• Acid perfusion (Bernstein test) – onset of symptoms
after ingestion of dilute HCL and saline is considered
positive. This test differentiates between cardiac and
non-cardiac pain.
26. Management:
• Treatment goals include system elimination, healing
esophageal damage and preventing complications and
relapse
27. Contd…
Lifestyle modifications:
• Head of bed raised 6- 8 inches (15-20 cm).
• Do not lie down for 3-4 hours after eating – time
frame for greatest reflux.
• Avoid overeating – causes LES relaxation
28. Contd…
• Bland diet: avoid garlic,
onion, peppermint,
fatty foods, chocolate,
coffee, citrus foods,
colas and
tomato products
29. Contd…
• No tight fitting clothes.
• Weight control
• Smoking cessation
• Reduce alcohol
30. Contd...
Pharmacological treatment:
• Antacids – reduce gastric acidity. Use on as need basis,
relief symptoms but do not heal esophageal lesions.
• H2 receptor antagonist (ranitidine, cemetidine) –
decrease gastric acid secretion.
31. Contd…
•If symptoms do not responds to H2 receptor blockers,
change to a once-per-day PPI, such as pantoprazole,
omeprazole to block gastric acid seretion.
• Prokinetic e.g. metoclopramide – strengthen the LES
and speed up gastric emptying
32. Contd…
Anti reflux surgery:
May be indicated for
patients who do not
respond to medical
management.
Common procedure is
Nissen fundoplication.
33. Contd…
Endoscopic treatment:
• The stretta procedure is a
radiofrequency energy
delivery system used to
provide a thermal burn
to the gastroesophageal
junction.
34. Contd…
• The EndoCinch procedure
uses an endoscopic sewing
device to create pleats with
a series of sutures passed
through adjoining folds
at the proximal fundus.
35. Contd…
• Enteryx, an endoscopically
implanted device,
prevents reflux of gastric acid
into the throat.
• The device is permanently
placed and may eliminate
need for pharmacologic
treatment of GERD symptoms.
37. Contd…
Nursing diagnosis:
• Pain related to irritation of the esophageal mucosa by
the gastric content.
• Imbalanced nutrition: less than body requirements
related to inability to intake enough food because of
reflux.
• Risk for aspiration related to esophageal compromise
affecting the lower esophageal sphincter.
38. contd…
Interventions:
• Advice the patient to avoid lying down immediately after
meals and late night snacks.
• Head of bed elevation and avoidance of meals 2-3 hours
before bedtime should be recommended for patients with
nocturnal GERD.
• Provide small frequent meals and avoid food that triggers
pain.
• If surgery was performed, provide pre and post- operative
care.
39. Contd…
• Monitor the complications of the disease and of
surgery
• Teach the patient about prescribed medications,
adverse effects and when to notify the health care
providers.
• Familiarize the patient and family with foods and
activities to avoid such as fatty foods, garlic, onions,
alcohol, coffee, chocolates etc..
• Prevent aspiration by avoiding supine position
40. Complications:
• Reflux esophagitis: the main complication.
• Anemia due to bleeding
• Esophageal stricture
• Esophageal ulcer
• Replacement of the normal squamous epithelium
with columnar epithelium (barrett's epithelium).
• Reflux aspiration: may lead to chronic pulmonary
disease.
41. Prognosis
• Most patients with GERD do well with medications,
although a relapse after cessation of medical therapy is
common and indicates the need for long term
maintenance therapy.
• The LOTUS trial – a 5 year, exploratory, randomized ,open,
parallel group trial, demonstrated that with anti-reflux
therapy with GERD , either using drug- induced acid
suppression with esomeprazole or laparoscopic anti-reflux
surgery, most patients achieve remission and remain in
remission at 5 years.
42.
43.
44.
45. References:
• Sandra m,N.(2010). Lippincott Manual of Nursing Practice. 10th Ed.
Page number 666.B New York: Wolters Kluwer Health| Lippincott
Williams and Wilkins.
• Belleza, M.(2019). Gastroesophageal reflux. NursesLabs. Retrieved on
23rd sept, 2020 from https://nurseslabs.com/gastroesophageal-
reflux-disease-gerd-nursing-care-plans/.
• Patti g, m.(2019). Gastroesophageal Reflux Disease. Medscape.
Retrieved on 23rd sept, 2020 from
https://emedicine.medscape.com/article/176595-overview.
• Suddarth, B. a. (2014). A Textbook of Medical Surgical Nursing. New
Delhi: wolter kluwers pvt ltd.
