Nurses are also educators, and their role in providing patent education and guiding patients through their health concerns is crucial. The more aware a patient and their caretakers are, the better the chances of improving health outcomes.
As a nurse, one of the most common conditions that you can encounter is Gastroesophageal Reflux Disease (GERD). Gastroesophageal Reflux Disease affects a significant portion of the population, and patients rely on your expertise to help manage and treat this condition.
In this Fast CE For Less guide, we’ll explore what GERD is, the causes, symptoms, how it is diagnosed, and available treatments, equipping you with the knowledge to assist your patients better.
What is GERD?
Gastroesophageal Reflux Disease (GERD) is a chronic problem in which a person’s stomach acids flow into the esophagus, causing discomfort and potential damage to the esophageal lining. This backflow, often referred to as acid reflux, causes irritation in the esophagus lining and can lead to more serious complications if left untreated. GERD is a more severe form of acid reflux, and patients with GERD typically experience symptoms more than twice a week.
What is Acid Reflux?
Before diving into GERD specifically, it’s important to understand the relationship between GERD and acid reflux. Acid reflux happens when a person’s lower esophageal sphincter (LES) weakens or relaxes inappropriately. When it happens, this ring of muscle, which acts like a valve between the esophagus and stomach, allows stomach acid to escape into the esophagus. While occasional acid reflux is common, frequent episodes may indicate GERD.
Causes of GERD
Several factors can contribute to the development of GERD, and as a nurse, you can help patients identify and manage these risks:
- Overweight and Obesity: Excess weight, particularly around the abdomen, increases pressure on the stomach, which can force acid up into the esophagus.
- Overeating: Large meals increase the amount of food and acid in the stomach, putting additional pressure on the LES.
- Eating and Laying Flat: Lying down immediately after eating makes it easier for stomach acid to escape into the esophagus.
- Caffeine: Beverages like coffee and tea can relax the LES, making acid reflux more likely.
- Alcohol: Alcohol can weaken the LES and irritate the lining of the esophagus.
- Spicy Foods: Spicy and acidic foods can make GERD symptoms worse or trigger them in some patients.
Symptoms of GERD
The symptoms of GERD vary in intensity, but they typically include:
- Heartburn: A burning sensation in the chest or throat, often after eating.
- Regurgitation: The sensation of acid backing up into the throat or mouth, leaving a sour or bitter taste.
- Chest pain: This can be mistaken for heart-related issues, making proper diagnosis important.
- Difficulty swallowing: Chronic acid exposure can cause scarring and narrowing of the esophagus.
- Chronic cough: Particularly at night, GERD can lead to a persistent, dry cough.
- Hoarseness or sore throat: Acid reflux can irritate the throat and voice box.
Diagnosing GERD
Proper diagnosis of GERD is essential for effective treatment. As a nurse, understanding the diagnostic tools available will help you explain the process to your patients:
Upper GI Series (Barium Swallow)
This test involves drinking a barium solution that coats the lining of the esophagus, stomach, and upper intestines. X-rays are then taken to observe abnormalities like a hiatal hernia, which can contribute to GERD.
Upper Endoscopy (EGD) – Esophagogastroduodenoscopy
An upper endoscopy allows direct visualization of the esophagus, stomach, and upper small intestine. A flexible tube with a camera is inserted down the throat, allowing the provider to look for inflammation, ulcers, or other signs of damage from acid reflux.
Bernstein Test
The Bernstein test simulates acid reflux by dripping a mild acid solution into the esophagus. If the patient’s symptoms are triggered, it suggests that acid reflux is the cause of their discomfort.
pH Monitoring
This test measures the acid levels in the esophagus over a 24-hour period, providing a detailed picture of how often acid reflux occurs and its severity. A small sensor is placed in the esophagus and connected to a monitor that tracks acid exposure.
Treatments for GERD
Treating Gastroesophageal Reflux Disease (GERD) requires a comprehensive approach that combines lifestyle changes, medications, and, in some cases, surgical interventions. As a nurse, you’re in a prime position to guide patients through these treatments and help them understand the importance of compliance. Let’s take a closer look at the primary treatment strategies for GERD.
Lifestyle Changes
Lifestyle modifications are often the first line of defense against GERD. Many patients can manage their symptoms by making targeted changes to their daily habits. You play a key role in educating patients about these adjustments, which can significantly reduce GERD symptoms. Here are the most critical lifestyle changes to encourage:
- Weight loss: Obesity is a significant risk factor for GERD because excess body weight, especially in the abdominal area, puts pressure on the stomach, which can push acid into the esophagus. Even modest weight loss can reduce symptoms in overweight patients. Encourage patients to adopt a balanced diet and regular exercise routine. Pointing them toward a dietitian or offering weight management programs can be particularly helpful.
- Eating smaller meals: Consuming large meals at once increases the volume of food in the stomach, putting more pressure on the LES (lower esophageal sphincter). By eating smaller, more frequent meals, patients can prevent excess pressure from building up and reduce the likelihood of acid reflux.
- Avoid lying down after meals: Lying down too soon after eating can allow stomach acid to flow more easily into the esophagus. Advise patients to stay upright for at least two to three hours after a meal. In patients with severe GERD, suggest elevating the head of their bed or using a wedge pillow to minimize nighttime symptoms.
- Avoid trigger foods: Certain foods are known to exacerbate GERD symptoms. These include spicy, fatty, and acidic foods, as well as caffeine and chocolate. Encourage patients to keep a food diary to identify specific triggers. Once identified, eliminating or limiting these foods can lead to noticeable symptom relief.
- Quit smoking: Smoking contributes to GERD by weakening the LES and increasing stomach acid production. While quitting smoking is challenging, offering resources like nicotine replacement therapy and referrals to smoking cessation programs can make a difference. Explain to patients that by quitting, they’re reducing GERD symptoms and improving overall health.
Medications
When lifestyle changes alone are not enough to manage GERD, medications are often prescribed to control acid production and relieve symptoms. Here are the most common types of medications used to treat GERD:
- Antacids: These over-the-counter medications provide quick relief by neutralizing stomach acid. They are especially useful for patients with mild, occasional heartburn. However, antacids do not heal an inflamed esophagus or prevent GERD symptoms in the long term. Encourage patients to use them as needed and not rely on them as a primary treatment.
- H2 Blockers: These medications reduce the amount of acid the stomach produces. They work longer than antacids but are not as strong as proton pump inhibitors (PPIs). H2 blockers can be purchased over the counter or prescribed at higher doses. They are especially helpful for managing nighttime reflux symptoms, as they can reduce acid production for several hours. As a nurse, you can guide patients on the appropriate use of these medications and monitor for any side effects, such as headaches or constipation.
- Proton Pump Inhibitors (PPIs): PPIs are among the most effective treatments for GERD because they block the production of stomach acid significantly and longer than H2 blockers. They are particularly beneficial for patients with more severe or chronic GERD. However, long-term use of PPIs should be monitored, as they may lead to side effects like vitamin B12 deficiency, osteoporosis, or kidney problems. You should also advise patients on the importance of adhering to prescribed dosages and consulting their healthcare provider before discontinuing or adjusting their medication.
- Prokinetics: These medications help improve the motility of the gastrointestinal tract, making the stomach empty faster and reducing the chances of acid reflux. They are less commonly used due to potential side effects such as fatigue or diarrhea, but they may be beneficial for patients whose GERD is due to slow gastric emptying.
Surgical Options
For patients with severe GERD who do not respond well to medications or lifestyle changes, surgical intervention may be necessary. Surgery can be particularly useful in cases where GERD has caused significant damage to the esophagus or when long-term medication use is not desirable. Here are two of the most common surgical treatments for GERD:
- Fundoplication: This is the most frequently performed surgical procedure for GERD. During fundoplication, the upper part of the stomach is wrapped around the LES to strengthen it, thus preventing acid from refluxing into the esophagus. This procedure has variations, including Nissen fundoplication, where the stomach is wrapped 360 degrees around the esophagus, and partial fundoplications, where only a portion of the stomach is used. This surgery is usually performed laparoscopically, meaning the recovery time is shorter, and the risk of complications is lower. Educating patients about the recovery process and potential side effects, such as difficulty swallowing in the early postoperative period, is essential for their preparation and post-surgical care.
- LINX Device: This relatively newer procedure involves placing a small ring of magnetic beads around the lower esophageal sphincter. The magnetic attraction between the beads keeps the LES closed to prevent acid reflux, but the ring expands to allow swallowing. Unlike fundoplication, the LINX device can be removed if necessary. This option is less invasive, and recovery time is generally quicker than traditional surgery. There is the potential for long-term success with this procedure, as studies have shown it can significantly reduce the need for GERD medications after placement.
Outcome of Treatments
With appropriate management, the outlook for GERD patients is generally positive. By following prescribed treatments and making lifestyle adjustments, most patients can experience significant relief from symptoms. Early diagnosis and intervention are key in preventing complications like esophagitis, strictures, or Barrett’s esophagus—a condition that can increase the risk of esophageal cancer.
Understanding the complexities of Gastroesophageal Reflux Disease (GERD) allows you, as a nurse, to better support your patients. From identifying symptoms to explaining diagnostic tests and treatment options, your guidance is essential in helping patients manage their condition. With proper education, lifestyle changes, and medical intervention, patients can lead more comfortable, symptom-free lives.
If you have not completed your nursing continuing education requirements to renew your license and want to learn more, online nursing CEUs offered by Fast CE For Less can help.
To access flexible and affordable nursing continuing education courses and state bundles, visit www.fastceforless.com.
