Running Head: GASTROESOPHAGEAL REFLUX DISEASE

Gastroesophageal Reflux Disease Claire Hobelmann University of South Florida

2 GASTROESOPHAGEAL REFLUX DISEASE In this paper, I will discuss gastroesophageal reflux disease (GERD) including its symptoms and prevalence, as well as what we, as nurses, can do to intervene in the clinical setting to help the patient. GERD is best defined as a condition in which food and acid frequently backflow into the esophagus (Pluta, Perazza, & Gotub, 2011). This is caused by weak muscles in the esophageal sphincter. It is estimated that 25-35% of the U.S. population experiences GERD at some point in their lifetime. The most frequent symptoms of GERD include heartburn, acid indigestion, and a bitter acid taste in the mouth. Chest pain, difficulty swallowing, and regurgitation of food or sour liquid are less common symptoms. If contents of the stomach reach the larynx, coughing can occur (Pluta et al., 2011). Furthermore, particular foods can worsen GERD, such as chocolate, citrus, spicy foods, caffeine, and alcohol. There are many different lifestyle changes that a patient can make and interventions that the nurse can perform to reduce the symptoms of GERD. Smokers should stop smoking, aggravating foods should be avoided, and extra weight should be lost if needed. In addition, the patient should eat small, frequent meals, and avoid tight-fitting clothing. Lastly, the patient should refrain from lying down within 3 hours after eating a meal, and the head of the bed should be raised 6 to 8 inches (Fennerty & Gold, 2012). There are also many different medical interventions which can help relieve the symptoms of GERD. Antacids, such as Alka-Seltzer and Mylanta, can be administered to neutralize the acids in the stomach (Fennerty & Gold, 2012). H2 blockers, such as nizatidine and ranitidine, can decrease acid production. Also, proton pump inhibitors, such as Prilosec and Prevacid, can heal the esophageal lining (Fennerty & Gold, 2012). Some patients may take a combination of these drugs. If the symptoms of GERD still persist after making lifestyle changes and taking medicines, then more invasive procedures can be conducted. A barium swallow radiograph,

3 GASTROESOPHAGEAL REFLUX DISEASE upper endoscopy, or pH monitoring examination can be performed by a doctor to test for any abnormalities. If these tests show that there is indeed an abnormality, surgery can be implemented. A fundoplication can strengthen the sphincter, prevent acid reflex, and repair a hiatal hernia (Fennerty & Gold, 2012). A majority of the aforementioned interventions can be conducted in the clinical setting. Ensuring that the patient does not lie down after eating and making sure the head of the bed is raised is a very specific intervention that nurses can perform. Moreover, nurses can make certain that the patient receives smaller, more frequent meals that will not aggravate their stomach and esophagus. They can also administer the antacids, H2 blockers, and proton pump inhibitors, after they have been prescribed by a physician. Other members of the healthcare team, such as doctors and surgeons, can perform the medical tests, such as pH monitoring, as necessary. Some of the ways to reduce symptoms of GERD, however, must be initiated and maintained by the patient themselves. Nurses can certainly encourage the patient to quit smoking and begin a healthier diet, but it is up to the patient to take that first step and stay motivated enough to continue it. Although I did not take care of a patient with GERD, from my knowledge of this disease I can presume that the appropriate nursing interventions would be easy to implement. Since I did not have a clinical experience, I read a case study about a 31 year old patient who was diagnosed with GERD and I thought I would share my findings. The patient presented with recurrent chest pain and regurgitation, but otherwise considered himself healthy. Research has shown that chest pain and regurgitation indicates a diagnosis of GERD in 80% of all cases (Pandolfino, 2013). Blood work and physical examination showed that he had high blood pressure and cholesterol, and he is overweight. It is recommended that he lose weight and exercise to reduce his

4 GASTROESOPHAGEAL REFLUX DISEASE symptoms, but it is noted that these changes alone will not eliminate his symptoms completely. He is then started on proton pump inhibitor therapy (PPI). In this article I also found that about 36% of Americans experience heartburn at least once per month, yet only 9% of those people seek medical advice (Pandolfino, 2013). Heartburn is the most common sign of GERD, but patients may use heartburn to describe a number of other digestive symptoms which could indicate underlying conditions. Therefore, a claim of heartburn must always be thoroughly investigated. If a patient presents with heartburn coupled with dysphagia, vomiting, or atypical symptoms such as asthma or chronic cough, an endoscopy should be performed.

5 GASTROESOPHAGEAL REFLUX DISEASE References Fennerty, M.B., & Gold, B.D. (2012, April 30). Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD). Retrieved from http://digestive.niddk.nih.gov /ddisease/pubs/gerd/#5 Pandolfino, J. E. (2013). Case Study: Alarm Over Chest Pain and Regurgitation. Retrieved from http://practicingclinicians.com/wb2_pdfs/CPCE42507-7B_GERD_v10.pdf Pluta, R.M., Perazza, G.D., & Golub, R.M. (2011). Gastroesophageal Reflux Disease. The Journal of the American Medical Association,305(19), 2024. doi:10.1001/jama.305.19 .2024