Gastroesophageal Reflux (GERI)

 Gastroesophageal Reflux 

1.  Gastroesophageal reflux is the backward flow of gastric content into the esophagus.
   
2.  GERD common, affecting 15 — 20% of adults
3.  10% persons experience daily heartburn and indigestion. Because  location near other organs symptoms may mimic other illnesses including heart problems.

Etiology & Pathophysiology:

• Gastroesophageal reflux results from transient relaxation or incompetence of lower esophageal sphincter, sphincter, or increased pressure within stomach

•  Factors contributing to gastroesophageal reflux:

1.  Increased gastric volume (post meals)Position pushing gastric contents close to   gastroesophageal junction (such as bending or lying down)
2.  Increased gastric pressure (obesity or tight clothing) Hiatal hernia

•  Normally the peristalsis in esophagus and bicarbonate in salivary secretions neutralize any gastric juices (acidic) that contact the esophagus; during sleep and with gastroesophageal reflux esophageal mucosa is damaged and inflamed; prolonged exposure causes ulceration, friable mucosa, and bleeding; untreated there is scarring and stricture.

Symptoms of GERD :

•  Cough

•  dyspnea,

•  hoarseness

•  chest pain

•  Most common Heartburn (Pyrosis)

•   Felt as a retrosternal sensation of burning or discomfort Occurs usually after eating or when lying down or bending over Often relieved with milk or water Regurgitation

•  Effortless return of gastric and/or esophageal contents into the pharynx.It can induce respiratory  complications if gastric contents spill into the tracheobronchial tree

 Complications:

 👉 Esophageal strictures, which can progress to dysphagia o Barrett's esophagus: changes in cells lining esophagus with increased risk for esophageal cancer

Nursing management of (GERI):

• Avoid factors that cause reflux

• Stop smoking

• Small, frequent feeding of nonirritating foods are recommended

• Avoid acid or acid producing foods o

• Elevate HOB -300  

• Do not lie down 2 to 3 hours after eating o Drug therapy

• Evaluate effectiveness

• Observe for side effects