Gastroesophageal reflux disease (GERD) is a condition in which the reflux of gastric contents causes symptoms and complications that impair quality of life (Patti, 2019). The usual symptoms of GERD are regurgitation and heartburn; however, several difficulties with breathing, such as chronic cough, asthma, laryngitis, etc. may occur. The pathogenesis of GERD involves the relaxations of transient lower esophageal sphincter and pressure abnormalities of other lower esophageal sphincter (Patti, 2019). It leads to pancreatic enzymes, reflux of acid, pepsin, and bile to occurring and causing esophageal mucosal injury.
Among other factors that cause GERD, there is hiatal hernia, which stimulates lower esophageal sphincter dysfunction (Nirwan et al., 2019). There is also delayed gastric emptying, which is responsible for emptying, resulting in gastric distention and can increase the rate of transient lower esophageal sphincter relaxations (Patti, 2019). Impaired esophageal clearance, which leads to the prolonged acid exposure of mucosa, and impaired mucosal defensive factors that are responsible for preventing GERD, by neutralizing the back diffusion of hydrogen ion into the esophageal tissue, are crucial as well (Patti, 2019).
The researches have suggested that GERD is the result of gastric acid contacting the esophageal mucosa, thus causing different levels of damage (Nirwan, 2019). However, the nature of this occurrence is not yet known to the researchers. Although, they have emphasized two theories: gastric acid has direct contact with the upper airway and the vagal reflex of acid of the distal esophagus, both leading to bronchospasm, which causes the symptoms of GERD (Nirwan, 2019).
GERD is generally known as a chronic relapsing condition when the stomach content is refluxed into the esophagus, which causes the symptoms of heartburn and regurgitation (Patti, 2019). These symptoms are the most common among the population, but they do not necessarily do much damage and discomfort, so people usually do not seek medical advice. It is due to the general nature of symptoms that occur in a large part of the population without any implications and go away without any medical interference. However, the symptoms can develop in further complications and become pathological; in that state, they are harder to treat.
Heartburn and regurgitation are typical symptoms and may not cause much damage to the patient with GERD (Nirwan, 2019). On the other hand, more severe complications, such as erosive esophagitis, Barret’s esophagus and esophageal carcinoma can develop if one does not visit a doctor. In rare cases, symptoms such as dysphagia, pain in the chest, asthma, chronic cough, and laryngitis may occur, caused by GERD; however, such cases are not typical for the disease (Nirwan, 2019).
Most patients experience mucosal breaks or some esophageal injuries at endoscopy, which does not cause erosion of the esophagus; thus, it is called “non-erosive reflux disease” (Patti, 2019). It should be seen not as a separate sickness, but rather the extension of GERD.
In cases when GERD develops aggressive symptoms, that are harmful to the esophagus, and interact with esophageal, gastric junction barrier, esophageal acid clearance, and mucosal resistance, which typically protect the throat from any danger, it can cause duodenal and gastric disease (Nirwan, 2019). Therefore, contact with acid, pepsin, bile, and other duodenal contents, which are called esophageal mucosa of refluxate, plays a significant part in developing GERD (Patti, 2019).
Acid is one of the crucial reasons for developing GERD and its further complications, such as Barret’s esophagus carcinoma (Nirwan, 2019). The severity of symptoms and complications increase with the duration of esophagus exposure to acid. Pathogenesis of GERD also includes the biliary acids, pancreatic enzymes and can result in severe symptoms and complications.
People with pre-existing conditions that are not related to GERD are in the groups of risk in developing complications and more severe symptoms. The risk groups include patients with cancer, people with immunodeficient diseases, and other health problems (Nirwan, 2019). Such patients should visit a doctor when the first symptoms appear to avoid developing the disease into further complications. Additionally, in the risk groups of patients who can develop GERD are people who suffer from obesity, and pre-existing conditions mentioned above, such as hiatal hernia, scleroderma (connective tissue disorders, and delayed stomach emptying) (Nirwan, 2019).
Pregnant women are at increased risk of developing GERD, therefore healthy eating and seeking medical advice should be a priority if the symptoms appear. Some factors can exaggerate the existing, mild symptoms, which are heartburning and regurgitation. Among other factors, most common are smoking, eating large portions or late at night, eating fried food with too much oil, which is called a trigger for the GERD, drinking too much alcohol, soda or coffee, so-called beverage drinks (Nirwan, 2019). Taking painkillers or other medications that were not prescribed also puts one at risk of aggravating the disease.
To diagnose GERD and check the stage of the disease and its complications can be used as one of the following methods: upper endoscopy, ambulatory acid probe test, esophageal manometry, a scan of the upper digestive system (Patti, 2019).
If the GERD id confirmed and adequately diagnosed, and no complications revealed, the medications are prescribed to relieve the pain and treat the symptoms. Among prescribed medications are antacids for neutralizing acid, as well as reduce the production of acid, or block it, and heal the esophagus (Nirwan, 2019). Stronger medication focused on preventing the receptors, strengthen proton pump inhibitors, and strengthen the esophageal sphincter (Nirwan, 2019). The prescribed medicine can only treat the symptoms and ease them. However, it is usually not enough, and a patient must follow a diet plan and reduce all the risks that can aggravate the disease.
In cases with severe development of GERD complications, when medications do not help, doctors may advise surgical interference. However, usually prescribed medications help to control the disease.
NANDA suggests a list of nursing diagnoses that are different from medical diagnosis since nurses respond to the current potential threat to one’s life, and medical diagnosis is based on ambulatory tests (Rabelo‐Silva et al., 2016). One of nursing diagnosis is altered comfort, dyspepsia related to reflux of gastric contents. Among possible symptoms for the diagnosis could be inadequate food intake, altered taste, weight loss, vomiting, abdominal pain and discomfort, heartburn, regurgitation (Rabelo‐Silva, et al., 2016). Based on visual symptoms and a questionary, nurses prepare a patient for the ambulatory diagnostic procedures; therefore, the nurse’s diagnosis must be precise to avoid unnecessary procedures that could aggravate the condition of the patient.
As for nursing interventions and rationales, there are three for discussion respectfully in this paper (Rabelo‐Silva, et al., 2016):
- Obtaining nutrition history – since the bad food habits usually the leading cause for GERD, the nutrition plan is crucial in changing habits and maintaining healthy eating throughout treatment and after;
- Small meals containing high protein – small portions with high consistency of protein are better for digestion;
- Upright position for two hours after the meal and going to sleep 3 hours after the last meal – sitting and lying down right after eating causes reflux action into the esophagus (Rabelo‐Silva, et al., 2016).
The symptoms of GERD are usually mild for most people and may eliminate with proper care and treatment. However, in rare cases, and for patients in risk groups, it can develop into further health complications and cause GERD related diseases. Therefore, people with pre-existing conditions and those who experience more severe symptoms should seek medical advice for precise diagnosis to avoid aggravating the health state.
References
Nirwan, J., Yousaf, M., Conway, B., & Ghori, M. U. (2019). Management of Gastrointestinal Disorders and the Pharmacist’s Role: Gastroesophageal Reflux Disease: GERD. In Z-U-D. Babar (Ed.), Encyclopedia of Pharmacy Practice and Clinical Pharmacy (1 ed.). Elsevier Ltd.
Patti, M. G. (2019). Gastroesophageal Reflux Disease.
Rabelo‐Silva, E. R., Cavalcanti, A. C. D., Caldas, M. C. R. G., Lucena, A. de F., Almeida, M. de A., Linch, G. F. da C., … Müller‐Staub, M. (2016). Advanced Nursing Process quality: Comparing the International Classification for Nursing Practice (ICNP) with the NANDA‐International (NANDA‐I) and Nursing Interventions Classification (NIC).