Pathophysiology - Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease (GERD)

• Also known as reflux esophagitis – esophageal mucosa breaks down
• Syndrome resulting from esophageal reflux
• Manifestations are often overlooked and attributed to stress
• 10% of the population has daily GERD

Etiology

• Inappropriate relaxation of the LES (exact cause is unknown)
• Reflux occurs with
• Alteration in the intervention of the pressure zone in the region of the gastroesophageal sphincter
• Displacement of the angle of the gastroesophageal junction
• An incompetent LES

Risk Factors

• Obesity and weight gain
• Pregnancy
• Chewing tobacco/smoking
• High-fat foods
• Theophylline
• Caffeine and chocolates
• High levels of estrogen and progesterone

Pathophysiology

Normally, there is high-pressure zone in the region of the gastroesophageal sphincter and high pressure prevents reflux but permits passage of food and liquids. When there is alteration, reflux occurs.

Clinical manifestations

• Onset is sudden or gradual
• Client may complain of heartburn, odynophagia, dysphagia, acid regurgitation
• Pain is described as burning sensation that moves up and down
• Pain after meals relieved with antacids or fluids
• Lifting and straining aggravates the pain

Diagnosis

• Barium swallow
• Analysis of gastric secretions
• Acid perfusion test
• Esophageal manometry
• Esophageal biopsy
• Esophagoscopy
• Cytologic examination

Medical Management

1. Cytotec – prevent gastric ulcerations especially for clients under NSAID
2. Antacids – for prompt relief initially given 1 hour before and 2 to 3 hours after meals (neutralizes gastric secretions)
3. Histamine receptor antagonist – to decrease gastric acid secretions
4. Cholinergics – given with severe manifestations to increase LES pressure and prevent reflux
5. Gastrointestinal stimulants – it increases LES pressure by stimulating the smooth muscle of the GI tract and increase the rate of gastric emptying. Taken before meals.
6. Proton pump inhibitors – suppresses secretion of gastric acid

Surgical management

1. Nissen fundoplication – most common and involves suturing the fundus around the esophagus
2. Hill operation – narrows the esophageal opening
3. Belsy (Mark IV) repair
4. Angelchick prosthesis

Nursing Management

• Prevent respiratory distress (cough and deep breathing exercises)
• Prevent wound infection
• Prevent gas-bloat syndrome – bloating and inability to eructate
• Avoid carbonated beverages, gas producing foods
• Drink with a straw
• Ambulate to bring peristalsis
• Decrease reflux with lifestyle and diet changes
• Small frequent feedings
• Drink adequate fluids at meals
• Eat and chew food slowly to increase salivation
• Avoid extremely hot and cold foods, spices, fats, coffee, chocolate, and citrus juices
• Avoid drinking for 3 hours before retiring to prevent nocturnal reflux
• Avoid tobacco, salicylates and phenylbutazone which may exacerbate esophagitis