Gastroesophageal Reflux Disease

Less LES pressure means more reflux

▪ Disease that affects
the ring of the muscle ▪ Normally, the LES maintains enough pressure
between the around the lower end of the esophagus to
close it and prevent reflux.
esophagus and your
▪ Typically, the sphincter relaxes after each
stomach. swallow to allow food into the stomach.
▪ This ring is called LES. ▪ In GERD, the sphincter doesn’t remain closed
▪ Popularly known as (usually because of deficient LES pressure
Heartburn or pressure within the stomach that exceeds
LES pressure), and the pressure in the
stomach pushes the stomach contents into
▪ In normal the esophagus. The high acidity of the
digestion, your stomach contents causes pain and irritation
when the contents enter the esophagus
LES open to
allow food into
your stomach.
What is LES?
▪ Lower esophageal sphincter (LES) is a bundle
of muscles at the low end of the esophagus,
where it meets the stomach.
▪ Is a circular band of muscle at the end of
▪ Then it closes to stop food and acidic
your esophagus. When its working properly, it
stomach juices from flowing back into your relaxes and opens when you swallow. Then it
esophagus. tightens and closes again afterwards.
▪ Gastroesophageal reflux happens when the
LES is weak or relaxes when it shouldn’t.
This let’s the stomach’s contents flow up
How it happens?
into the esophagus.

Causes:
▪ GERD is
caused by
frequent
acid
reflux.
▪ When you
swallow, a circular band of muscle
around the bottom of your esophagus
(lower esophageal sphincter) relaxes to
allow food and liquid to flow into your What to look for??
stomach. Common signs and symptoms includes:
▪ Then the sphincter closes again. ▪ A burning sensation in your chest
▪ If the sphincter relaxes abnormally or (Heartburn), usually after eating, which
might be worse at night.
weakens, stomach acid can flow back up
▪ Chest pain
into your esophagus. This constant
▪ Dysphagia (Difficulty of swallowing)
backwash of acid irritates the lining of
▪ Regurgitation of food or sour liquid
your esophagus, often causing it to
▪ Sensation of a lump in your throat
become inflamed.
 Gastroesophageal Reflux Disease
Factors that can aggravate acid ▪ Precancerous
changes to the
esophagus
reflux include: (Barret’s
esophagus).
▪ Smoking
Damage from
▪ Eating large meals or eating late at night acid can cause
▪ Eating certain foods (triggers) such as changes in the tissue lining the lower
fatty or fried foods esophagus. These changes are
▪ Drinking certain beverages, such as associated with an increased risk of
esophageal cancer.
alcohol or coffee
▪ Raking certain medications, such as
aspirin How is GERD Diagnosed and Treated?
Physical Exam and Tests:
Risk Factors: ▪ Medical history
▪ Food diary (note foods that give
Conditions that can increase your risk includes: you symptoms)
▪ Obesity Ambulatory acid probe test:
▪ Bulging of the top of the stomach up ▪ This test measures how much acid is
in your stomach over 24 hours.
into the diaphragm (Hiatal hernia)
▪ Insert thread a long, thin, flexible
▪ Pregnancy tube called a catheter through your
▪ Connective tissues disorders, such as nose and down your esophagus.
scleroderma X-rays:
▪ Delayed stomach emptying ▪ Swallow a chalky liquid called
barium. It will coat the inside of
your throat, stomach, and upper
Complications intestines.
Endoscopy:
Overtime, chronic inflammation in your esophagus
▪ Will put a long, thin tube and tiny
can cause: camera into your digestive tract to
▪ Narrowing of look for damage. It will thread
the esophagus through your nose and down your
(esophageal esophagus.
stricture) Manometry:
Damage to the ▪ Your doctor will thread a long, thin
tube into your esophagus to
lower esophagus from stomach acid measure how your esophagus moves
causes scar tissue to form. and how it pushes acid upward.
▪ The scar tissue narrows the food
pathway, leading to problems with
swallowing. Treatments:
▪ An open OTC “ANTACIDS”
sore in the ▪ Medications help get rid of stomach
esophagus acid and ease mild heartburn. They
(esophageal include your drinks (Maalox, Milk of
ulcer). Magnesia, Mylanta) and chewable
Stomach tablets (Rolaids, Tums)
acid can ▪ Won’t heal ulcers or fix damage to
wear away tissue in the esophagus, your esophagus from long term
causing an open sore to form. An
GERD.
esophageal ulcer can bleed, cause pain
and make swallowing difficult.
 Gastroesophageal Reflux Disease
H-2 receptor blockers: Nursing Management:
-These work slower than antacids, but they ease
symptoms for a longer time, up to 12 hours. They o Eat a low-fat, high-fiber diet.
include cimetidine (Tagamet HB), famotidine (Pepcid
AC), and nizatidine) o Avoid irritants, such as spicy or acidic foods,

alcogol, caffeine, and tobacco, because they

increase gastric acid production.

o Avoid food or drink 2-3 hours before

bedtime or lying down after eating.

o Elevate the head of the bed on 6” to 8”

books or 45 degrees.

Proton pump inhibitors: o Lose weight if necessary.

-Medicines offer stronger acid relief than H-2
receptor blockers. They also can help heal
damage in your throat and esophagus from acid
reflux.
-Includes esomeprazole (Nexium), lansoprazole
(Prevacid 24HR), omeprazole (Prilosec),
pantoprazole (Protonix), and rabeprazole
(AcipHex).

Surgery:
Linx surgery
-Wraps a ring of
tiny beads around
your esophagus
where it goes into
your stomach.

Nissan
fundoplication
-Wraps the top part
of your stomach
around the lower part of your esophagus.