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GastroesophagealReflux Disease
Figure 1.0. Structure of the Esophagus
Definition:
Gastro esophageal reflux disease is a chronic and
relapsing condition in which prolonged reflux of Symptoms of GERD:
hydrochloric acid, pepsin and bile salts in esophagus, Esophageal
oral cavity and respiratory system occurs that leads • Heartburn
to esophagitis. • Dysphagia (difficulty swallowing)
• Odynophagia (painful swallowing)
What causes GERD? • Regurgitation (the action of bringing
GERD is caused by a weak or relaxed lower sphincter; swallowed food up again to the mouth.)
the junction between the esophagus and the stomach. • Belching, otherwise known as burping or
eructation, (is the act of expelling air from
Pathogenesis of GERD the stomach through the mouth to reduce
1. Impaired lower esophageal sphincter the distention.)
2. Hypersecretion of acid Extraesophageal
3. Decreased acid clearance resulting from • Cough
impaired peristalsis or abnormal saliva • Wheezing
production.
• Hoarseness of Voice
4. Delayed gastric emptying or duodenogastric
• Sore throat
reflux of bile salts and pancreatic enzymes.
• Globus sensation (persistent sensation of a
lump in the throat)
Main Symptoms of GERD
Heartburn, Difficulty Swallowing, Flatulence (buildup • Epigastric Pain
of gas in the digestive system that can lead to • Non-cardiac chest pain (NCCP)
abdominal discomfort.), Dry Throat and Vomiting.
Frequent Symptoms
1. Acid Reflux
2. Chest or abdominal pain
3. Hoarseness
4. Difficulty swallowing or Dysphagia
, 5. Persistent Dry Cough 2. Ambulatory acid
6. Bad Breath
7. Wheezing
8. Nausea / Vomiting
9. Difficulty Sleeping
The esophageal pH test is an outpatient
Figure 1.1 Endoscopy procedure performed to measure the pH or
amount of acid that flows into the
esophagus from the stomach during a 24-
Diagnostic Work-ups hour period.
The procedure is commonly used to
help confirm the diagnosis of GERD or to
1. Upper endoscopy identify the cause of various symptoms,
including:
1. Heartburn, primarily in
patients who have had a normal endoscopy
and who have failed medical treatment or
may be considered as candidates for surgery
2. Uncommon symptoms of
GERD (gastroesophageal reflux disease), such
as chest pain, chronic cough, asthma, and
other throat symptoms.
The equipment used in the
esophageal pH test consists of a small probe
that is inserted through your nostril and
It is a procedure used to visually examine positioned near the lower esophagus. The
your upper digestive system with a tiny probe is plugged into a small unit (or
camera on the end of a long, flexible tube. monitor) worn on your belt or over your
The tube is put into your mouth and throat. shoulder.
Then it is slowly pushed through your A newer, wireless device may make
esophagus and stomach, and into your monitoring the pH level easier: Instead of
duodenum. Video images from the tube are having to have a tube placed down your
seen on a monitor. nose for 24 hours, your doctor will place a
disposable capsule into the esophagus using
an endoscope. The capsule then wirelessly
, transmits information for up to 48 hours to a Barium Swallow
receiver worn around the waist. A. Signs of esophagitis including:
1. Thickening of the esophageal folds.
3. Esophageal manometry 2. Erosions.
3. Ulcerations.
4. Strictures.
B. Disadvantages
1. Less sensitive than endoscopy for
demonstrating esophagitis.
2. Biopsy specimens can’t be taken.
Nursing Diagnosis
1. Imbalance nutrition less than body requirements
2. Acute pain
3. Imbalance nutrition more than the body
requirements
4. Risk for aspiration
5. Deficient knowledge
6. Anxiety
7. Risk for injury
It is a test that is used to measure the
Nursing Management
function of the lower esophageal sphincter 1. Teach the client to avoid factors that
(the valve that prevents reflux, or backward increase lower esophageal irritation.
flow, of gastric acid into the esophagus) and 2. Eat a low-fat, high-fiber diet, high calories d
the muscles of the esophagus. This test will high protein.
tell your doctor if your esophagus is able to 3. Avoid irritants, such as spicy or acidic foods,
move food to your stomach normally. alcohol, caffeine, and tobacco, because they
increase gastric acid production.
4. X-ray of upper digestive system 4. Avoid food or drink 2 hours before bedtime
Upper or lying down after eating.
gastrointestinal 5. Elevate the head of the bed on 6” to 8”
tract radiography, bocks.
also called an 6. Lose weight if necessary.
upper GI, is an x- 7. If symptoms persist, prepare the client for
ray examination of surgical repair, which includes a
the esophagus, funduplication (i.e. wrapping a portion of the
stomach and first part of the small intestine gastric fundus around the sphincter area of
(also known as the duodenum). Images are the esophagus)
produced using a special form of x-ray called 8. Administer medications, which may include
fluoroscopy and an orally ingested contrast antacids, histamine-receptor antagonists,
material such as barium. and proton-pump inhibitors.
9. Small frequent meals.
, 10. Remain in upright position at least 2 hours extraesophageal symptoms such as regurgitation
after meals. compared to individuals with daytime GERD.
11. Instruct to eat slowly and to masticate foods 1ndividuals with nighttime GERD may wake up more
well. often choking or coughing or with regurgitation (ie,
an acid or sour taste in their mouth) at nighttime.
Figure 1.3 Lifestyle Changes to help treat GERD
Hiatus Hernia
Complications Hiatal Hernia
A hiatal hernia occurs when the upper part of the
• Barrett's esophagus is a condition in which
stomach pushes through an opening in the
the esophagus, the muscular tube that carries food
diaphragm, and up into the chest. This opening is
and saliva from the mouth to the stomach, changes so
called a esophageal hiatus or diaphragmatic hiatus.
that some of its lining is replaced by a type of tissue
A hiatus hernia or hiatal hernia is the
similar to that normally found in the intestine.
protrusion of the upper part of the stomach into the
• Esophageal Cancer is cancer that occurs in
chest through a tea or weakness in the diaphragm.
the esophagus — a long, hollow tube that runs from
your throat to your stomach. Your esophagus helps
Figure 1.4. Comparison between normal GI tract and
move the food you swallow from the back of your
system with hiatal hernia
throat to your stomach to be digested. Esophageal
cancer usually begins in the cells that line the inside
of the esophagus.
• Erosive Esophagitis is a type of esophagitis
in which there is esophageal damage. Esophagitis is
inflammation, irritation, or swelling of the lining of
the esophagus, which is the tube that runs from the
throat to the stomach.
• Esophageal Strictures refers to the abnormal
narrowing of the esophageal lumen; it often presents
as dysphagia commonly described by patients as Figure 1.5. Symptoms of Hiatal Hernia
difficulty swallowing. It is a serious sequela to many
different disease processes and underlying etiologies.
Its recognition and management should be prompt.
• Nighttime Reflux- Individuals who have
significant nighttime GERD tend to have increased
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