Gastro-Esophageal reflux disease (GERD)

Definition:

GERD is not a disease but a heterogeneous syndrome resulting from esophagus reflux. Most cases are attributed to the inappropriate relaxation of the lower esophageal sphincter (LES) in response to unknown stimulus.

Etiology:

  1. Common cause is Hiatus Hernia
  2. Increases intra-abdominal pressure (Obesity, Pregnancy)

Clinical features:

  1. Heart burn
  2. Wheezing
  3. Hoarseness
  4. Dysphonea
  5. Nausea
  6. Vomiting
  7. Regurgitation
  8. Dysphagia
  9. Odynophagia
  10. Bleeching

Investigations:

  1. Gastro-esophagealscopy
  2. Barium swallow
  3. Biopsy

Medical Management:

  1. Antacids (to relieve heart burn)
  2. Histamine 2 receptors
  3. Prokinetic drugs (to increase LES)
  4. Proton pump inhibitor (to inhibit the enzymatic activity)

Surgery:

  1. Anti-reflux surgery

Nursing Management:

  1. Patient should be encouraged to eat 4-6 small meals daily
  2. Follow a low-fat, adequate protein diet
  3. Eliminate alcohol, beverages and tobacco
  4. Avoid constrictive clothing over the abdomen
  5. Elevate the bed at least 6-8 inches
  6. Never sleep flat on the bed

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