Pathophysiology of Gastroesophageal Reflux Disease
1.The nurse practitioner (NP) diagnoses a client with gastroesophageal reflux disease (GERD).
The NP explains to the client that the condition is caused by which of the following?
a) Reverse peristalsis of the stomach
b) Excessive salivation and swallowing
c) Loss of muscle tone at the lower esophageal sphincter
d) Increased production of bile in the stomach
Gastroesophageal reflux disease (GERD) is commonly associated with the loss of muscle tone at
the lower esophageal sphincter (LES). The LES is a muscular ring that separates the esophagus
from the stomach, and its relaxation or incompetence can lead to the backward flow of stomach
contents into the esophagus, causing the symptoms characteristic of GERD, such as heartburn
and regurgitation.
2.Larger volumes of gastric contents generally increase gastric pressure, stimulating peristalsis
and promoting a faster rate of gastric emptying. Hypertonic solutions, having a higher osmotic
pressure than the surrounding tissues, tend to delay gastric emptying.
3.The nurse practitioner (NP) evaluates a client with complaints of a burning sensation in the
chest that often occurs after meals and is exacerbated when lying down. Which of the following
findings should the NP recognize as risk factors for gastroesophageal reflux disease (GERD)?
Select all that apply.
a) Has a sliding hiatal hernia
b) Smokes 1 pack of cigarettes per day
c) Body mass index (BMI) of 32
d) Drinks three cups of chamomile tea daily
e) Takes aspirin daily for coronary artery disease
Increased body mass index (BMI), especially in the overweight or obese range, is a recognized
risk factor for gastroesophageal reflux disease (GERD). Increased abdominal pressure due to
excess weight can contribute to the reflux of stomach contents into the esophagus. Smoking is a
known risk factor for GERD. Smoking can weaken the lower esophageal sphincter, which
contributes to the development or exacerbation of GERD symptoms. Hiatal hernias, especially
sliding hiatal hernias, are associated with GERD. The herniation of the stomach through the
diaphragmatic opening can disrupt the normal anatomical barrier, allowing gastric acid to flow
back into the esophagus and causing symptoms such as heartburn.
Risk Factors
, Obesity slows gastric emptying, which leads to prolonged retention of food in the
stomach and increases the likelihood of stomach contents refluxing into the esophagus.
Smoking can weaken the lower esophageal sphincter, which can allow stomach acid to
flow into the esophagus.
Hiatal hernias constitute a structural risk factor for GERD. A hiatal hernia occurs when a
portion of the stomach protrudes through the diaphragmatic opening (hiatus) into the
chest cavity. This displacement of the stomach can impact the lower esophageal
sphincter, making it less effective in preventing the backflow of stomach contents into the
esophagus.
Treatment
Initially, treatment includes prescribing a proton pump inhibitor (PPI) and lifestyle
changes such as diet modification, weight reduction, smoking cessation, elevating the head
of the bed, and avoiding tight clothing to alleviate symptoms.
4.The nurse practitioner (NP) evaluates a client who was prescribed omeprazole eight weeks ago
to treat suspected gastroesophageal reflux disease (GERD). The client reports the symptoms are
not improving after adhering to the prescribed medication regimen and lifestyle change
recommendations. Which of the following actions should the NP take?
a) Increase the dosage of the omeprazole
b) Discontinue omeprazole and recommend antacids as needed
c) Order an esophageal endoscopy
d) Refer the client for a fundoplication
Persistent esophagitis suggests that the inflammation of the esophagus has not responded
adequately to the prescribed interventions. The client continuing to have symptoms may be due
to the development of esophageal strictures, which can hinder the passage of food and contribute
to ongoing discomfort. If gastric ulcers are detected, it could explain ongoing symptoms and
suggest that acid suppression therapy might not be effectively controlling acid production.
Identification of a hiatal hernia may contribute to ongoing symptoms, as it can facilitate the
reflux of stomach contents into the esophagus.
, Introduction to Obstructive Gastrointestinal Disorders
1.The nurse practitioner (NP) diagnoses a client with gastroesophageal reflux disease (GERD).
The NP explains to the client that the condition is caused by which of the following?
a) Reverse peristalsis of the stomach
b) Excessive salivation and swallowing
c) Loss of muscle tone at the lower esophageal sphincter
d) Increased production of bile in the stomach
Gastroesophageal reflux disease (GERD) is commonly associated with the loss of muscle tone at
the lower esophageal sphincter (LES). The LES is a muscular ring that separates the esophagus
from the stomach, and its relaxation or incompetence can lead to the backward flow of stomach
contents into the esophagus, causing the symptoms characteristic of GERD, such as heartburn
and regurgitation.
2.Larger volumes of gastric contents generally increase gastric pressure, stimulating peristalsis
and promoting a faster rate of gastric emptying. Hypertonic solutions, having a higher osmotic
pressure than the surrounding tissues, tend to delay gastric emptying.
3.The nurse practitioner (NP) evaluates a client with complaints of a burning sensation in the
chest that often occurs after meals and is exacerbated when lying down. Which of the following
findings should the NP recognize as risk factors for gastroesophageal reflux disease (GERD)?
Select all that apply.
a) Has a sliding hiatal hernia
b) Smokes 1 pack of cigarettes per day
c) Body mass index (BMI) of 32
d) Drinks three cups of chamomile tea daily
e) Takes aspirin daily for coronary artery disease
Increased body mass index (BMI), especially in the overweight or obese range, is a recognized
risk factor for gastroesophageal reflux disease (GERD). Increased abdominal pressure due to
excess weight can contribute to the reflux of stomach contents into the esophagus. Smoking is a
known risk factor for GERD. Smoking can weaken the lower esophageal sphincter, which
contributes to the development or exacerbation of GERD symptoms. Hiatal hernias, especially
sliding hiatal hernias, are associated with GERD. The herniation of the stomach through the
diaphragmatic opening can disrupt the normal anatomical barrier, allowing gastric acid to flow
back into the esophagus and causing symptoms such as heartburn.
Risk Factors
, Obesity slows gastric emptying, which leads to prolonged retention of food in the
stomach and increases the likelihood of stomach contents refluxing into the esophagus.
Smoking can weaken the lower esophageal sphincter, which can allow stomach acid to
flow into the esophagus.
Hiatal hernias constitute a structural risk factor for GERD. A hiatal hernia occurs when a
portion of the stomach protrudes through the diaphragmatic opening (hiatus) into the
chest cavity. This displacement of the stomach can impact the lower esophageal
sphincter, making it less effective in preventing the backflow of stomach contents into the
esophagus.
Treatment
Initially, treatment includes prescribing a proton pump inhibitor (PPI) and lifestyle
changes such as diet modification, weight reduction, smoking cessation, elevating the head
of the bed, and avoiding tight clothing to alleviate symptoms.
4.The nurse practitioner (NP) evaluates a client who was prescribed omeprazole eight weeks ago
to treat suspected gastroesophageal reflux disease (GERD). The client reports the symptoms are
not improving after adhering to the prescribed medication regimen and lifestyle change
recommendations. Which of the following actions should the NP take?
a) Increase the dosage of the omeprazole
b) Discontinue omeprazole and recommend antacids as needed
c) Order an esophageal endoscopy
d) Refer the client for a fundoplication
Persistent esophagitis suggests that the inflammation of the esophagus has not responded
adequately to the prescribed interventions. The client continuing to have symptoms may be due
to the development of esophageal strictures, which can hinder the passage of food and contribute
to ongoing discomfort. If gastric ulcers are detected, it could explain ongoing symptoms and
suggest that acid suppression therapy might not be effectively controlling acid production.
Identification of a hiatal hernia may contribute to ongoing symptoms, as it can facilitate the
reflux of stomach contents into the esophagus.
, Introduction to Obstructive Gastrointestinal Disorders
