NURS 308: TOPIC 19 - GERD, GASTRITIS, & ULCERS

What is the pathophysiology of gastroesophageal reflux disease (GERD)?

Stomach contents (acid) reflux into the esophagus, causing irritation and erosion of the mucosal lining.

What is the primary mechanism behind GERD?

Lower esophageal sphincter (LES) dysfunction, where it relaxes inappropriately and allows gastric contents to flow backward into the esophagus.

How does the LES contribute to GERD?

It fails to stay closed, leading to reflux of stomach acid into the esophagus.

What role does psychological stress play in GERD?

Higher levels of psychological stress can worsen or influence the severity of GERD symptoms.

What complications can occur with chronic GERD?

Barrett’s esophagus (premalignant), esophageal strictures, and esophageal adenocarcinoma.

What is Barrett’s esophagus?

A premalignant condition resulting from chronic GERD-related damage to the esophageal lining.

Why is GERD considered a risk factor for esophageal cancer?

Chronic acid exposure leads to cellular changes (metaplasia) that can progress to esophageal adenocarcinoma.

What is a major modifiable risk factor for gastroesophageal reflux disease?

Obesity

Which lifestyle factors can increase the risk of GERD?

Consuming spicy foods, caffeine, citrus, chocolate, peppermint, alcohol; smoking; lying down after eating

Why does lying down after eating increase GERD risk?

It allows stomach contents to reflux into the esophagus due to gravity loss

What types of beverages can contribute to GERD?

Caffeinated drinks and alcohol

Which foods are commonly associated with triggering GERD symptoms?

Spicy foods, citrus, chocolate, peppermint

How does smoking increase GERD risk?

It decreases lower esophageal sphincter (LES) pressure and impairs esophageal clearance

Which medical conditions are associated with increased GERD risk?

Hiatal hernia, scleroderma, pregnancy, obesity

Why does pregnancy increase the risk of GERD?

Increased intra-abdominal pressure and hormonal changes that relax the LES

How does a hiatal hernia contribute to GERD?

It allows part of the stomach to push above the diaphragm, promoting reflux

Which medical devices can increase the risk of GERD?

Nasogastric (NG) tube placement

Which medications are associated with increased GERD risk?

Anticholinergics and beta blockers

Why do anticholinergic medications increase GERD risk?

They reduce LES tone, allowing reflux

How can older age contribute to GERD?

Decreased LES tone and reduced esophageal motility

What condition involving the airway is linked to increased GERD risk?

Sleep apnea

How does sleep apnea contribute to GERD?

Increased intrathoracic pressure changes and pressure swings that promote reflux

Which combination of factors would most increase GERD risk?

Obesity, smoking, and frequent consumption of trigger foods or alcohol

What is heartburn (pyrosis) in GERD?

Burning sensation in the chest or throat, most common symptom

What is regurgitation in GERD?

Sour or bitter taste in the mouth after eating due to stomach contents flowing back up

What does dysphagia indicate in GERD?

Difficulty swallowing, may suggest esophageal stricture or esophagitis

What is odynophagia?

Painful swallowing

What is dyspepsia in GERD?

Upper abdominal discomfort or indigestion

Why do patients with GERD experience hoarseness or chronic cough?

Acid reaches the larynx and airway, causing irritation

What causes belching, nausea, or vomiting in GERD?

Gas and reflux of stomach contents

What causes abdominal bloating in GERD?

Increased gastric pressure from reflux

What is the priority nursing action when a patient reports chest pain with possible GERD?

Differentiate GERD chest pain from cardiac chest pain first

How does cardiac chest pain typically present compared to GERD?

Radiates to arm or jaw, associated with diaphoresis, not relieved by antacids

How does GERD chest pain typically present compared to cardiac chest pain?

Burning sensation, relieved by antacids, worsened by lying down or eating

What should you do if chest pain cannot be clearly identified as GERD or cardiac?

Treat as cardiac until proven otherwise; obtain EKG and troponins

What is the most accurate diagnostic test for GERD?

Esophageal pH monitoring — records acid exposure over 24–48 hours using a nasal catheter or capsule attached during EGD

What does esophageal pH monitoring measure?

pH levels in the esophagus in relation to food intake, body position, and activity

What diagnostic test is used to visualize esophageal tissue damage and allow biopsy?

Esophagogastroduodenoscopy (EGD) — identifies erosions and allows dilation of strictures and biopsy

What does esophageal manometry assess?

Lower esophageal sphincter (LES) pressure and esophageal peristalsis

What is the purpose of a barium swallow in GERD?

Identifies structural abnormalities such as hiatal hernia, strictures, and other esophageal changes

Which test evaluates structural abnormalities of the esophagus using contrast?

Barium swallow study

Which test is used to assess esophageal motility?

Esophageal manometry

Which GERD diagnostic test involves a probe or capsule placed in the esophagus for acid measurement?

Esophageal pH monitoring

What is a common subjective symptom of GERD related to chest discomfort?

Heartburn or a burning sensation in the chest or throat.

What taste may a client with GERD report in their mouth?

A sour taste.

What symptom involves the expulsion of gas from the stomach through the mouth in GERD?

Frequent belching.

What abdominal symptom is commonly reported with GERD?

Abdominal bloating.

What occurs when stomach contents move back into the esophagus in GERD?

Regurgitation.

What respiratory symptom may be associated with GERD due to irritation?

A chronic dry cough.

What repetitive behavior may a client with GERD exhibit due to throat irritation?

Frequent throat clearing.

What should be assessed when inspecting the oropharynx in a client with GERD?

Erosion or redness of the oropharynx.

Why should a nurse assess a client’s teeth in GERD?

To check for acid erosion from chronic reflux.

What is assessed when auscultating the abdomen in a client with GERD?

Bowel sounds.

What should be done when palpating the abdomen in a client with GERD?

Assess for tenderness, distention, or abnormalities.

Which assessment is the highest priority when a patient reports chest pain with suspected GERD?

Differentiate between cardiac & GERD-related chest pain.

What should be managed first if a patient with GERD has acute dysphagia?

Manage the airway/swallowing issue and correct dehydration or electrolyte imbalances if present.

What is the proper positioning intervention for a patient with GERD when sleeping?

Elevate the head of the bed when lying supine using bed blocks or a wedge pillow.

Why are extra pillows not recommended for elevating the head of the bed in GERD?

They do not maintain proper elevation and can worsen reflux positioning.

How long before bedtime should a GERD patient have their last meal?

At least 3 hours before bedtime.

Why is oral hygiene important in patients with GERD?

Stomach acid can damage teeth and oral tissues.

What dietary and lifestyle modifications should be taught to a patient with GERD?

Avoid trigger foods, alcohol, and smoking; lose weight if obese; avoid tight clothing; avoid exercising right after eating.

What classes of meds are used to treat GERD?

Proton pump inhibitors, antacids, histamine 2 receptor antagonists, prokinetics

What class of med is used as the 1st line treatment for GERD?

PPIs

What is the Stretta procedure used for in GERD?

Radiofrequency energy delivered via endoscope to reduce vagus nerve activity and tighten the lower esophageal sphincter (LES).

What is the expected effect of the Stretta procedure on the LES?

The LES muscle contracts and becomes tighter, reducing reflux.

What diet is recommended after a Stretta procedure on day 1?

Clear liquids only.

What diet progression is recommended after a Stretta procedure following day 1?

Soft diet for about 3–10 days.

What is a Nissen fundoplication?

A surgical procedure in which the fundus of the stomach is wrapped around the esophagus to create a barrier that prevents reflux.

When is fundoplication typically indicated?

When GERD does not respond to other treatments.

What type of surgical approach is used for Nissen fundoplication?

Laparoscopic.

What are key nursing priorities after fundoplication?

Monitor respiratory status, monitor for aspiration, dysphagia, abdominal pain, nausea, and vomiting, and advance the diet slowly.

What is a laparoscopic Heller myotomy used for?

Esophageal motility disorders.

What is the goal of a Heller myotomy?

To relax the lower esophageal sphincter by cutting its muscle fibers, improving esophageal emptying.

What is a major complication of GERD involving the lungs?

Aspiration of gastric secretions leading to aspiration pneumonia and respiratory infections

What is an important nursing intervention to reduce aspiration risk in GERD patients?

Place the patient in semi-Fowler’s position during meals and for 1–2 hours after, and keep oral suction available at bedside

What is Barrett’s esophagus?

A condition where normal squamous epithelium of the esophagus is replaced by columnar epithelium due to chronic acid exposure

Why is Barrett’s esophagus clinically significant?

It is premalignant and significantly increases the risk of esophageal adenocarcinoma

What are key nursing actions for a patient with Barrett’s esophagus?

Identify and address causes of GERD, reinforce lifestyle modifications, monitor nutritional status, and ensure regular endoscopic surveillance

What is a hiatal hernia?

Protrusion of part of the stomach through the diaphragm into the chest cavity

What is a sliding hiatal hernia?

The most common type where the stomach and gastroesophageal junction move upward into the chest

What is a rolling (paraesophageal) hiatal hernia?

A type where part of the stomach rolls through the diaphragm opening and sits alongside the esophagus

How are hiatal hernias generally managed?

With similar treatment as GERD, but severe cases may require surgical repair

What is gastritis?

Inflammation of the inner lining of the stomach (gastric mucosa)

What happens to the gastric mucosa in gastritis?

It becomes red and swollen

Can gastritis be acute or chronic?

Yes, it can be either acute or chronic

What occurs when mucosal integrity is compromised in gastritis?

Gastric acid can damage the underlying tissue

What can continued damage from gastric acid lead to?

Progressive erosion of the gastric lining

What happens to the gastric mucosa in chronic gastritis?

It becomes thin (atrophy)

What is atrophy in the context of chronic gastritis?

Thinning of the gastric mucosa

What functional change occurs with chronic gastritis?

Loss of normal cell function in the stomach lining

What is the most common cause of chronic gastritis worldwide?

H. pylori infection

What lifestyle factor can contribute to gastritis due to mucosal irritation?

Over-consumption of alcohol

Which types of foods can worsen gastritis symptoms?

Spicy, fried, or acidic foods

How do NSAIDs contribute to gastritis?

They inhibit prostaglandins that normally protect the gastric mucosa

What is a common infectious cause of acute gastritis?

Food poisoning

What is a stress-related factor that can lead to gastritis?

Acute stress

What lifestyle habit increases the risk of developing gastritis?

Smoking

What is autoimmune gastritis?

A condition where the immune system attacks gastric parietal cells

What condition can result from decreased intrinsic factor in autoimmune gastritis?

Pernicious anemia

What are common clinical manifestations of gastritis?

Loss of appetite, bloating, increased belching, nausea and vomiting, epigastric abdominal pain