Gastro Esophageal Reflex Disease (GERD)

• GERD is reflex (return) of gastric content (mainly acid) towards the mouth resulting in esophageal tissue damage.
• This is a chronic disease that occur when stomach acid (HCL) or bile flows into the food pipe and irritates the inner lining.
• GERD also known as Acid Reflex.

Causes or Etiology :-

• Hital Hernia
• Obesity
• 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 most common cause
• Reduce tone of LES (seen in scleroderma or systemic sclerosis)
• Food (Alcohol,caffine,tobacco,spicy food,fried food etc)

Clinical Feature :-

most common feature are:-

• Acidic taste in mouth
• Regurgitation (back flow)
• Heart burn

less common feature include :-

• pain with swollowing
• Short throat
• Increase salivation (water brash)
• Chest pain 
• Coughing
• Frequent bleching

GERD sometimes causes injury to the esophagus/ Complication :-

• Reflex esophagitis :- Inflammation of esophageal epithelium which can cause ulcers near the juction of stomach and esophagus
• Esophageal stryctures (narrowing) :-the persistent narrowing of the esophagus causes by reflex induced inflammation.
• Barredd's Esophagus :- Abnormal changes in the cells of the lower esophagus.
• Esophageal Adinocarcinoma :- A form of cancer.

Diagnosis :-

1. EGD :- Esophago Gastro Duedenoscopy:- visualization of the esophagus stomach and first part of small intestine.
2. Barium Swallow X-ray :- to assess the presence of esophageal strecture
3. Esophageal PH monitoring.

Medical management :-

•   Proton pump inhibitor
• H2 receptors antagonist
• Antacids
• Avoiding drugs like :- Aspirin,ibuprofen
• Avoiding of alcohol,tea,coffee etc.

Surgical Management :-

• 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 reflex.

Nursing Management :-

• Nursing management of GERD involves teaching the client to avoid situation that decrease lower esophageal sphincter pressure or cause esophageal irritation.

Nursing Intervention :-

• Monitor vital sign of the client.
• Assess abdomen for distention and intra abdominal pressure.
• Encourage the client to small frequent meals of high calories and high protein foods.
• Instruct the client remain upright position , at least two hours after meals and avoiding eating three hours before bed time.
• Instruct client to eat slowly and masticate food well.
• Advice to client to avoid spicy food and acidic food.
• Encourage the client to quit smoking and to loose weight if over weight.