GERD

• Gastroesophageal reflux disease (GERD) is the backflow of gastric or duodenal contents into the esophagus
• Causes of GERD may include: incompetent lower esophageal sphincter, pyloric stenosis, or motility disorders
• Clinical manifestations of GERD include:

  • Pyrosis
  • Dyspepsia
  • Regurgitation
  • Dysphagia or odynophagia
  • Hypersalivation
  • Esophagitis
• Assessment and diagnostic findings for GERD:

  • Endoscopy or barium swallow
  • Ambulatory 12-36 hour esophageal pH monitoring to determine the degree of acid reflux
  • Bilirubin monitoring (Bilitec) to measure bile reflux patterns
• Management strategies for GERD:

  • Teach client to avoid situations that decrease lower esophageal sphincter (LES) pressure or cause esophageal irritation
  • Follow a low-fat diet
  • Avoid caffeine, tobacco, beer, milk, and carbonated beverages
  • Avoid eating or drinking 2 hours prior to bedtime
  • Maintain normal body weight
  • Avoid tight-fitting clothing
  • Elevate the head part of the bed with 6-8 inch blocks
  • Elevate the upper body on a pillow
• Treatment options for GERD:

  • Antacids or H2 receptor antagonists (e.g., Famotidine, Nizatidine, Ranitidine)
  • Proton Pump Inhibitors (e.g., lansoprazole, raberpazole, Esomeprazole) to decrease the release of gastric acid
  • Prokinetic agents (e.g., Bethanechol, domperidone, metoclopramide) to accelerate gastric emptying
• Surgical option for GERD:

  • Nissen Fundoplication involves wrapping a portion of the gastric fundus around the sphincter area of the esophagus, can be done as open or laparoscopic surgery
• determine the degree of acid reflux

  ambulatory esophageal pH monitoring