There are four approaches for gastroesophageal reflux disease (GERD) treatment, including medication and surgery. Often, patients respond well to a combination of lifestyle changes and a medication regimen.
Some patients do not find satisfactory relief from those methods and require surgical intervention. Other patients may choose surgery as an alternative to a lifetime of taking medication.
Treatment Approaches for GERD
GERD Treatment: Lifestyle and Dietary Changes
Dietary and lifestyle changes are the first step in treating GERD. Certain foods make the reflux worse. Suggestions to help alleviate symptoms include:
GERD Treatment: Medication
If lifestyle and dietary changes do not work, your doctor may prescribe certain medications. There are two categories of medicines for reflux. One decreases the level of acid in your stomach, and one increases the level of motility (movement) in the upper gastrointestinal tract.
Over-the-counter antacids are best for intermittent and relatively infrequent symptoms of reflux. When taken frequently, antacids may worsen the problem. They leave the stomach quickly, and your stomach actually increases acid production as a result.
Histamine 2 (H2) blockers are drugs that help lower acid secretion. H2 blockers heal esophageal erosions in about 50 percent of patients.
Proton pump inhibitors
Proton pump inhibitors (PPIs) are drugs that block the three major pathways for acid production. PPIs suppress acid production much more effectively than H2 blockers. PPIs heal erosive esophagitis in many patients, even those with severe esophageal damage.
Prokinetic agents are drugs that enhance the activity of the smooth muscle of your gastrointestinal tract. These drugs are somewhat less effective than PPIs. Your doctor may prescribe them in combination with an acid-suppressing drug.
TIF and Other Endoscopic Therapy
Transoral incisionless fundoplication (TIF) is an option to address GERD. TIF can mean a shorter treatment time, less pain and faster recovery compared to laparoscopic surgery. The procedure involves using a special TIF device to create a passageway for a flexible, tube-like imaging instrument called an endoscope. The procedure allows the physician to use preloaded tweezers and fasteners to repair or recreate the valve that serves as a natural barrier to reflux.
Currently, there are clinical trials testing the efficacy of endoscopic therapy for GERD. One form of therapy uses an endoscopic sewing machine to place sutures in the stomach and increase the anti-reflux barrier.
If your symptoms did not improve with lifestyle changes or drug therapy, you may be a candidate for surgery. Some patients prefer a surgical approach as an alternative to a lifetime of taking medications. The goal of surgery for reflux disease is to strengthen the anti-reflux barrier.
During a procedure known as a Nissen fundoplication, your surgeon wraps the upper part of your stomach around the lower esophagus. This enhances the anti-reflux barrier and can provide permanent relief from reflux. Your surgeon may perform this surgery laparoscopically, which means a less invasive procedure with a shorter recovery time.
Reflux may affect more than just the esophagus. Reflux can lead to inflammation of the pharynx (part of the throat right behind the mouth) and larynx (voice box). It may also cause bronchitis, asthma or pneumonia. If there are no obvious causes for the inflammation, your doctor may suspect reflux. The goal of treatment is to improve the symptoms through medication.
This NCLEX review will discuss GERD (gastroesophageal reflux disease).
As a nursing student, you must be familiar with GERD and how to care for patients who are experiencing this condition.
These type of questions may be found on NCLEX and definitely on nursing lecture exams.
Don’t forget to take the GERD quiz.
You will learn the following from this NCLEX review:
Lecture on GERD
What is GERD?
GERD stands for Gastroesophageal Reflux Disease and it is a chronic condition where stomach contents flows back up into the esophagus which is mainly due to a damaged/weak lower esophageal sphincter.
GERD is sometimes referred to as “acid reflux disease” as well.
Some people have random episodes of acid reflux and it goes away, but GERD is when it occurs more than twice a week for a long period of time.
Why is GERD happening? In a nutshell, the LES (lower esophageal sphincter) is not staying closed but opening. This allows backwash of stomach contents and acids into the esophagus, and this leads to major irritation to the esophagus. See below the reasons for a weak/damaged LES.
First let’s cover what happens in normal swallowing:
Physiology of swallowing food:
Digestion starts in the mouth when food is chewed. Then it is swallowed. The food is then squeezed down into the esophagus and the lower esophageal sphincter relaxes to let the food into the stomach and then it CLOSES again to prevent the food from back flowing. Parietal and chief cells are stimulated from the food to produce acid and digestive enzymes to break down the food. In GERD, the acids and food can flow back into the esophagus.
Key Players in GERD
Esophagus: the tube that connects to the stomach to allow food to enter into the stomach. It squeezes food down into the stomach each time we swallow and the lower esophageal sphincter opens. It plays a role in GERD if the esophagus is unable to perform this role correctly due to impaired motility.
Esophageal mucosal lining: erodes and becomes damaged over time from the constant backwash of acids/contents and ulcer/sores form…hence “esophagitis”….complications: esophageal cancer, Barrett’s esophagus, narrowing of the esophagus, bleeding
Stomach Acid & Contents: erodes the esophagus….if the acid and contents makes it pass the upper esophageal sphincter it can enter into the lungs causing pneumonia, aggravate asthma signs and symptoms, coughing, ear infections, voice changes, chronic cough, and night time coughing…..called laryngopharyngeal reflux (GERD can lead to this)
Complications of GERD
Signs and Symptoms of GERD
Note: not all people with GERD will have heartburn but may have chronic cough, recurrent pneumonia, regurgitation of food
How is GERD Diagnosed?
Treatment of GERD: lifestyle changes, medications, surgery such as: fundoplication which is where the fundus of the stomach is placed around the lower part of the esophagus (most severe cases)
Nursing Interventions for GERD
Assess quality and characteristic of the pain and differentiate the signs and symptoms from a heart attack?
Assess for other signs and symptoms rather than heartburn…do they have respiratory changes, dry cough that is worst when lying down, hoarseness of the voice? Is the pain aggravated when eating a heavy meal? What food makes it worst? (help develop a diet plan to decrease signs and symptoms) What medications are they taking?
Assess for signs and symptoms of aspiration? Coughing, voice changes, lower oxygen saturation, increase respiration, abnormal lung sounds
Education for GERD
Medications for GERD
Antacids: neutralizes acid
Histamine-receptor blockers: decreases secretion of gastric acid
Proton-pump Inhibitors (PPIs): decreases stomach acid and helps esophagus heal
Prokinetics: prevent delayed gastric emptying by improving pressure in LES and peristalsis of the GI tract:
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