GERD or Acid Reflux- causes, diagnosis, symptoms,management
What is GERD or Acid Reflux?
- Gastro-Esophageal Reflux Disease (GERD) is reflux (return) of gastric content (mainly acid) towards the mouth resulting in esophageal tissue damage.
- This is a chronic disease that occurs when stomach acid (HCL) or bile flows into the food pipe and irritates the inner lining.
- Gastro-Esophageal Reflux Disease (GERD) also known as Acid Reflux.
Causes or Etiology of GERD:-
- Hiatal Hernia.
- Zollinger Ellison Syndrome:-Hyper-secretion of gastric acid.
- delayed gastric emptying.
- delayed esophageal clearance.
- Increases Intra-abdominal pressure.
- Inappropriate relaxation of LES (lower esophageal sphincter):- It is the most common cause.
- Reduce the tone of LES (seen in scleroderma or systemic sclerosis).
- Food (Alcohol, caffeine, tobacco, spicy food, fried food, etc).
Clinical Feature of GERD:-
most common feature are:-
- Acidic taste in the mouth.
- Regurgitation (backflow).
less common feature include:-
- pain with swallowing.
- Short throat.
- Increase salivation (water brash).
- Chest pain.
- Frequent bleaching.
GERD sometimes causes injury to the esophagus/ Complication:-
- Reflux esophagitis:- Inflammation of esophageal epithelium which can cause ulcers near the junction of the stomach and esophagus.
- Esophageal strictures (narrowing):-the persistent narrowing of the esophagus caused by reflux induced inflammation.
- Barrett’s Esophagus:- Abnormal changes in the cells of the lower esophagus.
- Esophageal Adenocarcinoma:- A form of cancer.
Diagnosis of GERD:-
- EGD:- Esophago Gastro Duodenoscopy:- visualization of the esophagus stomach and first part of the small intestine.
- Barium Swallow X-ray:- to assess the presence of an esophageal stricture
- Esophageal PH monitoring.
Management of GERD:-
- Proton pump inhibitor.
- H2 receptors antagonist.
- Avoiding drugs like- Aspirin, ibuprofen.
- Avoiding alcohol, tea, coffee, etc.
- Nissen Fundoplication:- In this procedure, the upper part of the stomach is wrapped along the lower esophageal sphincter to strengthen the sphincter and prevent acid reflux.
- Nursing management of Gastro-Esophageal Reflux Disease (GERD) involves teaching the client to avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation.
- Monitor the vital signs of the client.
- Assess the abdomen for distention and intraabdominal pressure.
- Encourage the client to small frequent meals of high calories and high protein foods.
- Instruct the client to remain upright position, at least two hours after meals, and avoiding eating three hours before bedtime.
- Instruct the client to eat slowly and masticate food well.
- Advice to clients to avoid spicy food and acidic food.
- Encourage the client to quit smoking and to lose weight if overweight.
See also:- Gastritis or Stomach Inflammation