Gastroesophageal Reflux Disease (GERD)

Overview

• Lecture by: Sarth Regis
• Profession: Nurse
• Platform: ran.com (Video part of NCLEX review series on GI system)
• Includes free review quiz (Link in description)

What is GERD?

• Full Form: Gastroesophageal Reflux Disease
• Involves: Stomach (gastro-) and esophagus (esophageal)
• Condition: Stomach contents flow back into the esophagus
• Esophagus cells can't handle stomach acid, leading to irritation
• Caused by a weak or damaged Lower Esophageal Sphincter (LES)
• Also known as: Acid Reflux Disease
• Defined as GERD: Acid reflux occurring twice a week or more regularly

Normal Swallowing Physiology

• Process:
  • Food is chewed and swallowed
  • Esophagus (smooth muscles) moves food to the stomach
  • LES relaxes to allow food into the stomach then tightly closes

GERD Pathophysiology

• Issues with Components:
  • Esophagus: Impaired motility, irregular LES closure leading to acid backflow
  • Lower Esophageal Sphincter (LES): Becomes weak due to pressure, medications, chemicals
  • Esophageal Mucosal Lining: Acid erosion causing ulcers
  • Stomach Acid and Food Contents: Increase in backflow and irritation

Causes of Increased LES Pressure

• Pregnancy: Baby pushes diaphragm which pressures LES
• Obesity: Increased abdominal pressure
• Overeating: Large meals increase stomach pressure
• Hiatal Hernia: Top part of stomach herniates through diaphragm, increasing LES pressure
• Medications and Chemicals: Histamines, calcium channel blockers, sedatives, smoking
• Foods: Fatty, greasy foods, peppermint, spearmint weaken LES
• Delayed Gastric Emptying: Anticholinergics can cause

Esophageal Mucosa Issues

• Conditions: Esophagitis (inflammation), increased risk of esophageal cancer
• Complications: Strictures (narrowing of esophagus), Barrett's esophagus (cell lining change, cancer risk), bleeding

Potential Extent of Acid Impact

• Laryngo-Pharyngeal Reflux: Acid can move to pharynx, causing ear infections, pneumonia, respiratory issues, hoarseness

Signs and Symptoms of GERD

• Heartburn: Burning sensation in chest; can mimic heart attack symptoms
• Epigastric Pain: Stomach pain
• Regurgitation: Bitter taste, food coming back up
• Dry Cough: Worse at night
• Nausea
• Difficulty Swallowing: Feeling of lump in throat
• Recurrent Lung and Ear Infections

Diagnosis of GERD

• Endoscopy: Visual examination of esophagus
• Esophageal Manometry: Assesses esophageal function and LES closure
• pH Monitoring: 24-hour tube to measure acid contact with esophagus

Treatment of GERD

• Lifestyle Changes: Weight loss, diet change, quit smoking
• Medications
• Surgery: Fundoplication for severe cases (stomach fundus around esophagus to strengthen LES)

Nursing Interventions

• Assessment: Frequency and quality of pain, signs of aspiration, medication history
• Patient Education:
  • Diet: Small meals, avoid trigger foods (fatty, greasy foods, alcohol, coffee, peppermint, spearmint, soft drinks)
  • Meal Timing: Last meal 3 hours before bedtime, sit up after meals
  • Weight Management: Especially if obese
  • Smoking Cessation
  • Avoid Acidic Foods: Tomatoes, citrus fruits, juices

Medications for GERD

• Antacids: Neutralize stomach acid (e.g., Magnesium Hydroxide, Calcium Carbonate)
  • Avoid taking with other medications
• Histamine Receptor Blockers: Block histamine, reduce acid production (e.g., Ranitidine, Famotidine)
  • Short-term use, avoid with antacids
• Proton Pump Inhibitors (PPIs): Decrease stomach acid, help esophagus heal (e.g., Omeprazole, Pantoprazole)
  • Long-term use can increase bone fracture risk
• Prokinetics: Promote gastric emptying, improve LES pressure (e.g., Metoclopramide)