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Understanding Gastroesophageal Reflux Disease
In the field of Nursing, there is a broad variety of health issues to consider and one such condition is 'Gastroesophageal Reflux Disease'.
Known in short as GERD, Gastroesophageal Reflux Disease is a long-term medical condition that affects the digestive system.
What is Gastroesophageal Reflux Disease?
Among the conditions that future nurses are expected to understand, Gastroesophageal Reflux Disease (GERD) may strike as challenging due to its multifaceted nature.
GERD is defined as a chronic and more serious form of gastroesophageal reflux (GER), a medical term referring to the backward flow of stomach acid into the esophagus.
To picture what happens, think of GERD as a faulty valve. In a well-functioning esophagus, the lower esophageal sphincter (a muscular ring at the bottom of the esophagus) closes off the esophagus from the stomach. If this valve weakens and does not close completely, the stomach acid can rise up and enter the esophagus, damaging its lining, and causing symptoms such as heartburn and regurgitation.
Gastroesophageal Reflux Disease Causes
In nursing, you'll find it is not enough just knowing about the disease, but also learning what causes them, and the most common reason for GERD is a weak lower esophageal sphincter. A table outlining the cause is given below:
| Cause | Explanation |
| Lower esophageal sphincter (LES) irregularities | If the LES does not close completely or if it opens too often, it allows stomach acid to rise into the esophagus. |
For instance, factors that can aggravate this LES discrepancy are obesity, smoking, certain types of food, medications, or even pregnancy. These factors can further weaken the LES or increase the amount of acid in the stomach, leading to GERD.
Common Gastroesophageal Reflux Disease Symptoms
While delving into the symptoms, it's crucial that future nurses consider both typical and atypical presentations. Below is a list of the signs typically associated with GERD:
- Heartburn (a burning sensation in the chest)
- Regurgitation (a sensation of acid backed up in the throat)
- Dyspepsia (stomach discomfort)
- Difficulty swallowing
- Chronic cough
These signs and symptoms can also be associated with chest discomfort, asthma, laryngitis and some cancers. Therefore, thorough understanding of these indications can play a vital role in early detection and treatment of GERD.
Self-Care Tips for Gastroesophageal Reflux Disease
As aspiring nurses, it's beneficial to understand the self-care tips and lifestyle changes which can alleviate the symptoms of Gastroesophageal Reflux Disease (GERD). Not only will you be better equipped to advise patients diagnosed with GERD, but you'll also be offering a much-needed remedy for a chronic condition that can significantly impact their quality of life.
Gastroesophageal Reflux Disease Self-Care: Lifestyle Changes
Opting for healthier lifestyle choices can significantly affect how you experience GERD symptoms. Here are some changes that can directly influence the severity and frequency of GERD:
- Maintaining a healthy weight: Excessive weight, particularly around the abdomen, puts added pressure on the stomach and can cause the LES to weaken, enabling acid reflux.
- Quitting smoking: Exposure to cigarette smoke weakens the LES, making it easier for stomach acid to reflux into the esophagus.
- Avoiding tight clothing: Clothes that fit tightly around your waist can press against your stomach and force food up into your esophagus, triggering acid reflux.
Consider a patient who is overweight, smokes regularly, and prefers tight clothing. This lifestyle could potentially intensify their GERD symptoms, and actively impair their overall well-being. Now, consider the same patient decides to quit smoking, lose weight, and wear loose clothing. These changes can help suppress the pressure on their stomach and thus, significantly ease their GERD symptoms over time.
Diet and Gastroesophageal Reflux Disease Self-Care
The diet plays an important role in controlling the symptoms of GERD.
Specific food and drink can trigger an aggressive LES relaxation and an increased stomach acid production, leading to the discomfort associated with GERD.
Below is a table of certain food items that can provoke acid reflux:
| Food/Drink | Explanation |
| High-fat foods | These slow down digestion and can lead to an increase in stomach pressure. |
| Spicy meals | They can raise stomach acidity. |
| Citrus fruits and juices | These have high acidity levels. |
| Alcohol | It relaxes the LES, allowing acid to reflux into the oesophagus. |
Interestingly, cutting down on the foods and drinks that trigger GERD can not only help in managing the symptoms but can also offer other health benefits such as weight loss and better heart health. However, everyone is different, so it's key for patients to monitor their own food triggers.
On a positive note, several foods are considered 'safe' and are less likely to cause GERD. These include:
- Oatmeal
- Ginger
- Leafy vegetables
- Lean meats: These include white-meat poultry, fish, and seafood.
Medical Management of Gastroesophageal Reflux Disease
Moving beyond self-care and lifestyle modifications, you should also familiarise yourself with the key aspects of the medical management of GERD. The goal of such treatment is not only to alleviate the symptoms but also to promote healing, prevent complications and reduce the chances of recurrence.
Common Gastroesophageal Reflux Disease Medications
In the medical management of GERD, a variety of medications are used to decrease the amount of acid in the stomach, thus reducing the damage to the esophagus and helping prevent the uncomfortable symptoms associated with GERD.
The main categories of GERD medications include antacids, H2 blockers, and proton pump inhibitors (PPIs).
- Antacids: These are over-the-counter medications that neutralise stomach acid. They provide quick relief but don't heal the esophagus if the lining is damaged.
- H2 Blockers: They decrease acid production. They're available in both over-the-counter and prescription forms.
- Proton pump inhibitors (PPIs): These block acid production and heal the esophagus. They are stronger than H2 blockers and are typically used if you've tried other treatments without success. PPIs are available over the counter and in prescription form.
For a patient enduring significant heartburn, an antacid might be suggested for quick relief. Should the symptoms be recurrent, H2 blockers might be prescribed to suppress acid production. For more severe or persistent cases, PPIs would be the next line of treatment to not only block acid production but also facilitate the healing process.
Advanced Gastroesophageal Reflux Disease Treatments
If medications don't provide enough relief for a GERD patient, then advanced treatments such as surgery or other procedures might be recommended. It's essential to bear in mind that these are usually considered when other options have failed or aren't suitable due to other medical considerations.
| Treatment | Explanation |
| Fundoplication | This is a surgical procedure where the top of the stomach is wrapped around the lower esophageal sphincter to tighten the muscle and prevent reflux. |
| Transoral incisionless fundoplication (TIF) | A less invasive form of the procedure, it uses a device to create a barrier preventing the reflux of stomach acid. |
The TIF procedure offers less invasive surgical options compared to standard fundoplication. TIF provides the advantage of no external incisions and reduced side effects, resulting in a faster recovery time. However, like all surgeries, it carries certain risks and considers a patient's overall health and lifestyle.
In addition to these procedures, there are also devices such as the 'LINX device' that can be installed around the lower esophagus. The LINX device is a ring of magnets that help keep the lower esophageal sphincter closed when not swallowing, hence preventing acid reflux.
Beyond surgery and devices, other treatments can be considered as well. For example, Stretta procedure which uses radiofrequency energy to improve the function of the lower esophageal sphincter. The choice of an advanced treatment is highly individualised and depends on the patient's specific condition and needs.
Gastroesophageal Reflux Disease - Key takeaways
- Gastroesophageal Reflux Disease (GERD) is a chronic and more severe form of gastroesophageal reflux (GER) which results from the backward flow of stomach acid into the esophagus.
- Common symptoms of GERD include heartburn, regurgitation, stomach discomfort, difficulty swallowing and chronic cough.
- The primary cause of GERD is a weak lower esophageal sphincter (LES) which allows stomach acid to rise into the esophagus. Factors aggravating this weakness can include obesity, smoking, certain foods, medicines, and pregnancy.
- Self-care and lifestyle changes for managing GERD involve maintaining a healthy weight, quitting smoking, avoiding tight clothing, and moderating the consumption of certain foods and drinks
- Medical management of GERD includes treatments with medications such as antacids, H2 blockers, and proton pump inhibitors (PPIs), and in severe cases, surgical procedures such as fundoplication and transoral incisionless fundoplication (TIF) or the use of devices such as the LINX device.
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