ESOPHAGEAL DISORDERS

Achalasia

• absent or ineffective peristalsis of the distal esophagus accompanied by failure of the esophageal sphincter to relax in response to swallowing.

• Narrowing of the esophagus just above the stomach results in a gradually increasing dilation of the esophagus in the upper chest.

• Rare, may progress slowly, and occurs most often in people between ages 20 and 40 and ages 60 and 70 years.

1. Loss of nerve cells in the esophagus; possibilities (viral infection of autoimmune responses; rarely: inherent genetic disorder or infection

2. dysphagia (main symptom), noncardiac chest or epigastric pain and pyrosis

Achalasia

1. Cause

2. Manifestation

1. x-ray studies

2. barium swallow

3. CT scan of the chest

4. endoscopy

5. high-resolution manometry

DIAGNOSTIC TEST (Achalasia):

1. __ - show esophageal dilation above the narrowing at the lower gastroesophageal sphincter, which is called a birds beak deformity.

2. B__

3. C__

4. E__

5. __- a process in which peristalsis, contraction amplitudes, and esophageal pressure is measured by a radiologist or gastroenterologist, confirms the diagnosis.

1. Dietary modifications

2. Botulinum toxin injection

3. Pneumatic dilation

MEDICAL MANAGEMENT (Achalasia):

1. __ Patient instructed to eat slowly and drink fluids with meals to facilitate passage of food.

2. __ Injected into the esophagus via endoscopy to inhibit smooth muscle contraction. Used only in patients not eligible for other definitive treatments due to limited duration of benefit and risk of fibrosis.

3. __ Involves stretching the narrowed esophageal area with a balloon; high success rate but often requires multiple sessions.

1. heller myotomy

2. per-oral endoscopic myotomy (POEM)

Surgical options (Achalasia):

1. __ (laparoscopic cutting of esophageal muscle fibers, often with fundoplication to prevent reflux).

2. __ A newer, minimally invasive alternative used in specialized centers.

1. Moderate sedation and analgesics/tranquilizers

2. botulinum toxin

PHARMACOLOGICAL MANAGEMENT (Achalasia):

1. __: Given during pneumatic dilation to manage pain and anxiety.

2. (__ could also be classified here since it is a pharmacological agent, but in this context it is delivered via a medical procedure).

1. Dietary teaching

2. (NPO status, informed consent, IV access).

3. Monitoring during procedures

4. perforation, bleeding, or reflux

5. severe chest pain, fever, difficulty swallowing after intervention

NURSING MANAGEMENT (Achalasia):

1. __: Reinforce instructions on eating slowly and drinking fluids with meals.

2. Pre-procedure care: Preparing patient for endoscopy, pneumatic dilation, or surgery (__, __, __).

3. __: Observing for adverse reactions to sedation/analgesia, maintaining airway, monitoring vitals.

4. Post-procedure care: Assess for complications such as __, __, or __; provide pain management support.

5. Patient education: Teaching about the disease process, importance of follow-up, recognizing warning signs (e.g., __, __, __ after intervention).

esophageal spasm

• abnormal functioning of nerves, opioids

are abnormal muscle contractions in your esophagus (the tube that takes food and drink to your stomach after you swallow). These spasms make it harder for food to reach your stomach.

cause: __, __

1. jackhammer esophagus

2. diffuse esophageal spasm (DES)

3. type III (spastic) achalasia

The three types of esophageal spasm:

1. referred to as hypercontractile esophagus, spasms occur on >20% of swallows at a very high amplitude, duration, and length.

2. the spasms are normal in amplitude but are premature/uncoordinated, move quickly, and occur at various places in the esophagus at once.

3. is characterized by lower esophageal sphincter obstruction with esophageal spasms.

1. dysphagia, pyrosis, regurgitation, and chest pain

2. Esophageal manometry

Esophageal spasm

1. MANIFESTATION: __, __, __

2. DIAGNOSTIC TEST: __- which measures the motility and internal pressure of the esophagus, remains the standard test for irregular and high-amplitude spasms.

1. Dietary modifications

2. Botulinum toxin injection

   • Surgical interventions:

     3. Heller myotomy

     4. Per-oral endoscopic myotomy (POEM)

     5. antireflux procedures

MEDICAL MANAGEMENT: (Esophageal Spasm)

1. __: Small, frequent feedings and a soft diet to decrease esophageal pressure and irritation.

2. __: For frail patients who cannot tolerate other definitive interventions.

   • Surgical interventions:

     3. __ (cutting esophageal muscle fibers, often with antireflux procedure).

     4. __ as an alternative approach.

     5. Surgeries may include __ if GERD is also present.

1. Calcium channel blockers

2. Nitrates
   

3. Botulinum toxin

4. Proton pump inhibitors (PPIs):

PHARMACOLOGICAL MANAGEMENT: (Esophageal Spasm)

• Smooth muscle relaxants:

  1. __

  2. __
     → Reduce pressure and amplitude of esophageal contractions.

  3. __: Pharmacological agent used via endoscopic injection (classified here too).

  4. __: For patients with GERD symptoms to reduce acid reflux and irritation.

1. small, frequent meals and soft diet

2. hypotension, dizziness

3. pre- &post-procedure care

4. perforation, bleeding, worsening reflux

5. hot/cold foods

6. severe chest pain, dysphagia, or reflux

NURSING MANAGEMENT: (Esophageal spasm)

• Dietary teaching: Reinforce importance of (1)__ and soft diet.

• Medication teaching:

  • Educate about smooth muscle relaxants (side effects: ((2)__, __).

  • Teach proper timing of nitrates/CCBs for symptom relief.

  • Instruct on adherence to PPIs for GERD prevention.

• (3)__:

  • Preparing patient for myotomy or POEM (NPO status, consent, IV access).

  • Monitoring for complications such as (4)__, __, or __.

• Patient education:

  • Disease understanding and lifestyle modifications (avoiding triggers like very (5)__).

  • When to seek medical attention ((6)__, __, or __ not relieved by meds).

hiatal hernia

the opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper stomach moves up into the lower portion of the thorax; occurs more often in women than in men.

CUASE: Age-related changes in your diaphragm, Injury (trauma, surgery), Being born with a very large hiatus, Constant and intense pressure (coughing, vomiting, straining during a bowel movement, exercising or lifting heavy objects) on the surrounding muscles.

NURSING MANAGEMENT

• Postoperative care:

  • Advance diet slowly from liquids to solids.

  • Manage nausea and vomiting.

  • Track nutritional intake and monitor weight.

• Monitor for complications:

  • Early postoperative dysphagia (common in up to 50% of patients).

  • Belching, vomiting, gagging, abdominal distention, and epigastric chest pain → may indicate need for surgical revision.

  • Report any suspected complications immediately to provider.

• Patient education:

  • Reinforce lifestyle/dietary modifications (small meals, avoid reclining, head-of-bed elevation).

  • Educate on recognizing warning signs of obstruction or strangulation (severe pain, persistent vomiting, inability to pass gas/stool).

1. sliding hiatal hernia

2. paraesophageal hernia

3. II, III, or IV

two main types of hiatal hernia:

2. or type I, hiatal hernia occurs when the upper stomach and the gastroesophageal junction are displaced upward and slide in and out of the thorax.

2. occurs when all or part of the stomach pushes through the diaphragm beside the esophagus.

3. Types (depending on the extent of herniation) __, __, or __ ( has the greatest herniation, with other intra-abdominal viscera such as the colon, omentum, or small bowel present in the hernia sac that is displaced through the hiatus along with the stomach).

1. Pyrosis,(heartburn), Regurgitation, Dysphagia

2. no symptoms

3. GERD (gastroesophageal reflux disease)

4. (a)Volvulus; (b)Strangulation

MANIFESTATION:

Sliding Hiatal Hernia

1. Gastrointestinal Symptoms: (PRD)

2. Asymptomatic Cases: (N)

3. Associated Condition: __

4. Potential Complications

   • (a)__ (twisting of the intestine and mesentery causing bowel obstruction)

   • (b)__ (compromised blood supply leading to ischemia)

1. x-ray studies

2. barium swallow

3. esophagogastroduodenoscopy (EGD)

4. esophageal manometry

5. chest CT scan

DIAGNOSTIC TEST: (Hiatal Hernia)

1. x__

2. b__

3. __ which is the passage of a fiberoptic tube through the mouth and throat into the digestive tract for visualization of the esophagus, stomach, and small intestine

4. e__

5. c__

1. 1 hours

2. 4–8 inch (10–20 cm)

3. Toupet or Nissen fundoplication)

4. Open approaches

5. ischemia, necrosis, or perforation

MEDICAL MANAGEMENT: (Hiatal Hernia)

• Lifestyle & Dietary:

  • Frequent, small feedings that pass easily through the esophagus.

  • Avoid reclining for (1)__ after eating to prevent reflux/hernia movement.

  • Elevate head of bed on (2)__ inch ((3)__ cm) blocks to reduce sliding upward.

• Surgical Repair:

  • Indicated in symptomatic patients, mainly to relieve GERD symptoms.

  • Laparoscopic approaches preferred ((3)__).

  • (4)__ (transabdominal or transthoracic) for complicated cases (bleeding, adhesions, spleen injury).

  • Surgery also reserved for extreme cases with gastric outlet obstruction or suspected gastric strangulation → may lead to (5)__.

1. Proton Pump Inhibitors (PPIs)

2. H2 receptor antagonists

3. Analgesics

4. Antiemetics

PHARMACOLOGICAL MANAGEMENT: (Hiatal Hernia)

• GERD symptom control:

  1. __ or

  2. __ → to reduce gastric acid and reflux.

• Post-op medications (implied):

  3. __ for pain control.

  4. __ for nausea/vomiting.

diverticulum

1. pharyngoesophageal

2. midesopaghegeal

3. epinephric

4. pressure in the colon

Is an out-pouching of mucosa and submucosa that protrudes through a weak portion of the musculature of the esophagus; may occur in one of the three areas of the esophagus—

1. __ (upper)

2. __ - are uncommon. Symptoms are less acute, and usually the condition does not require surgery.

3. __- are usually larger diverticula in the lower esophagus just above the diaphragm. They may be related to the improper functioning of the lower esophageal sphincter or to motor disorders of the esophagus.

4. Cause: __ — possibly from spasms or straining

1. Zenker diverticulum (ZD)

2. Intramural diverticulosis

1. located in the pharyngoesophageal area

   • is caused by a dysfunctional sphincter that fails to open, which leads to increased pressure that forces the mucosa and submucosa to herniate through the esophageal musculature (called a pulsion diverticulum).

   • It is usually seen in people older than 60 years of age; most common type of diverticulum.

2. is the occurrence of numerous small diverticula associated with a stricture in the upper esophagus

1. dysphagia, fullness in neck, sour taste in mouth

2. coughing

3. belching, gurgling noises after eating, halitosis

MANIFESTATION: (Diverticulum)

1. Gastrointestinal / Swallowing Symptoms

• __ (primary symptom) – difficulty swallowing

• F__

• __(due to decomposed food in the pouch)

2. Respiratory Symptoms

• __ (from tracheal irritation or aspiration when food regurgitates, especially when lying down)

3. Other Clinical Manifestations

• B_

• G__ after eating

• __ (foul odor from decomposed food retained in the diverticulum)

1. barium swallow

2. manometric studies

3. esophagoscopy

4. blind insertion of NGT

DIAGNOSTIC TEST: (Diverticulum)

1. __- may determine the exact nature and location of a diverticulum.

2. __- performed for patients with epiphrenic diverticula to rule out a motor disorder.

3. __ - usually is contraindicated because of the danger of perforation of the diverticulum, with resulting mediastinitis (inflammation of the organs and tissues that separate the lungs).

4. __ should be avoided.

1. Rigid or flexible endoscopy.

2. Endoscopic septotomy

3. POEM (per-oral endoscopic myotomy)

4. Diverticulectomy

5. Cricopharyngeal myotomy

6. Open surgical repair

7. Epiphrenic & midesophageal diverticula

8. Intramural diverticula

MEDICAL MANAGEMENT: (Diverticulum)

• Endoscopic approaches:

  1. __

  2. __ (effective, recurrence 11–30%).

  3. __: newer option, lower recurrence risk.

• Surgical approaches:

  4. __ (removal of pouch).

  5. __ to relieve muscle spasm and prevent recurrence.

  6. __: careful to avoid injury to carotid artery and jugular vein.

• Other diverticula:

  7. __ → surgery if worsening/troublesome symptoms (diverticulectomy + long myotomy).

  8. __ → usually regress after dilation of associated stricture.

1. Anesthetics & sedatives

2. Analgesics

3. Antiemetics

4. Antibiotics

PHARMACOLOGICAL MANAGEMENT: (Diverticulum)

1. __: for endoscopic or surgical procedures.

2. __: for postoperative pain control.

3. __: to prevent nausea/vomiting post-op.

4. __ (if indicated): prophylaxis in case of risk of infection or leakage.

Diverticulum

NURSING MANAGEMENT:

• Preoperative:

  • Prepare patient for surgery or endoscopy (NPO, consent, IV access).

  • Provide education about the procedure.

• Postoperative:

  • Observe incision for leakage from esophagus and fistula formation.

  • Withhold food and fluids until x-ray confirms no leakage at surgical site.

  • Start with liquid diet → progress as tolerated.

  • Monitor for complications (bleeding, infection, aspiration).

• Patient education:

  • Explain need for gradual dietary advancement.

  • Teach signs of recurrence or complications (persistent dysphagia, regurgitation, chest pain).

  • Reinforce importance of follow-up after endoscopic or surgical treatment.

perforation

• endoscopy or intraoperative injury, foreign-body ingestion, trauma, malignancy

• Boerhaave syndrome

• Esophageal __ is a surgical emergency. When the wall of your esophagus is __ or torn, food, chemicals and bacteria from your gastrointestinal tract can escape into your chest. Immediate diagnosis and treatment are essential to minimize mortality. A delay of more than 24 hours is associated with higher mortality (20%) when compared to rapid recognition and treatment (7.4%).

• can occur at the cervical, thoracic, or abdominal portion of the esophagus.

  1. Cause:

  2. A spontaneous perforation associated with forceful vomiting or severe straining

1. infection, fever, Leokocytosis

2. pneumothorax, subcutaneous emphysema

MANIFESTATION: (Perforation)

1. (IFL)

2. mediastinal sepsis can occur with Boerhaave syndrome - which may be accompanied by __ and __

1. X-ray studies

2. Fluoroscopy

3. chest CT scan

DIAGNOSTIC TEST: (Perforation)

1. X__

2. __ {either a barium swallow or esophagram (a noninvasive test)}

3. __ -  may be used to identify the site and scope of the injury.

1. NPO status

2. IV fluid therapy

3. Supportive monitoring & care

4. drainage, diversion, stent placement, or esophagostomy.

5. 7 days

6. day 2–3

7. day 7

MEDICAL MANAGEMENT: (Perforation)

1. NPO status: immediate and strict to prevent further leakage.

2. IV fluid therapy: to maintain hydration and circulation.

3. Supportive monitoring & care: ICU-level monitoring often required.

   • Surgical interventions: (4) D__, D__, S__, or E__

   • Nutritional support:

     • NPO for (5)__ days.

     • Enteral feeding (jejunal) or parenteral nutrition starting day (6)__ post-op.

   • Diagnostic monitoring:

   • Repeat esophagram on day (7)__ to check for leaks/ileus before removing NG tube and resuming oral intake.

1. Ampicillin-sulbactam, Piperacillin-tazobactam, Carbapenems (e.g., imipenem)

2. Antifungal therapy

3. Analgesics

4. Sedatives/anesthetics

PHARMACOLOGICAL MANAGEMENT: (Perforation)

1. Broad-spectrum antibiotics (7–10 days post-op): __, __, __

2. __: Considered for immunosuppressed patients, HIV infection, or poor response to antibiotics.

3. __: for pain management (implied).

4. __: perioperative and ICU management (implied).

Perforation

NURSING MANAGEMENT: (Supportive care, monitoring, education)

• Preoperative & immediate care:

  • Keep patient NPO.

  • Initiate and maintain IV fluids.

  • Assist with preparation for surgery.

  • ICU-level monitoring of vitals and overall status.

• Postoperative care:

  • Maintain NPO ~7 days.

  • Provide oral comfort: moisten mouth with water only (no swallowing).

  • Ensure enteral/parenteral nutrition as ordered.

  • Monitor for complications: infection, leakage, ileus, nutritional deficits.

  • Observe for pain, fever, or worsening respiratory status.

• Follow-up care:

  • Monitor results of repeat esophagram before NG tube removal and resuming oral intake.

  • Reinforce importance of completing antibiotic therapy.

  • Educate patient/family about signs of complications (fever, chest pain, dysphagia, regurgitation).

Foreign Bodies

• Swallowed __ are objects that pass through the GI tract, usually without medical intervention.

• Some objects (dentures, fish bones, pins, small batteries, items containing mercury or lead) may injure or obstruct the esophagus and require removal.

• Causes: Swallowing dentures, fishbones, pins, small batteries, items containing mercury or lead

1. pain, dysphagia, dyspnea

2. X-ray

3. esophageal perforation

Foreign Bodies

1. Manifestations (PDD)

2. Diagnostic Test

            •__: Can identify the foreign body

3. is a surgical emergency that can result from foreign-body ingestion; immediate recognition and treatment are essential to reduce mortality

Foreign Bodies

MEDICAL MANAGEMENT

            •           Observation: Blunt, nontoxic objects may pass spontaneously.

            •           Endoscopic removal:

            •           Flexible endoscope with retrieval devices (forceps, graspers, snares, baskets, overtubes).

            •           Dilation techniques may help move objects into the stomach.

            •           Special considerations:

            •           Short-blunt objects, long objects, sharp-pointed objects, disc batteries, magnets, coins, narcotic packets.

            •           Ingested drug packets: Not removed endoscopically to avoid rupture; either no intervention or surgery is recommended.

            •           Timing: Typical intervention occurs within 24 hours if obstruction is present.

            •           Setting: Endoscopic procedure is usually performed in the endoscopy suite/clinic by a gastroenterologist under moderate sedation.

Glucagon (1mg IV)

Pharmacologic Management (foreign bodies)

• __ Relaxes the esophageal muscle to aid in passage.

Foreign Bodies

Nursing Management

            •           Assess for airway compromise (dyspnea, obstruction).

            •           Monitor pain, dysphagia, and breathing pattern.

            •           Prepare the patient for x-ray or endoscopy.

            •           Maintain NPO (nothing by mouth) before procedure.

            •          Assist the gastroenterologist during endoscopic removal.

            •           Provide support and reassurance to patient.

            •           Observe post-procedure for complications (perforation, bleeding, aspiration).

chemical burns

• off the esophagus occur after swallowing a strong acid or base, with alkaline agents being the most common.

• also occur from undissolved medications lodged in the esophagus or from swallowing a battery that releases caustic alkaline.

1. Intentional ingestion

2. Unintentional ingestion

3. Strong acids or bases

4. medications

5. Swallowing of batteries; button batteries

Causes (Chemical Burns)

1. __(67%; typically adults).

2. __ (33%; typically children).

3. __ (alkaline agents most common).

4. Undissolved __ in the esophagus.

5.  __ (__ release alkaline substances).

1. mediastinitis, systemic toxicity, odynophagia

  2.

• Esophagoscopy: To determine the extent and severity of injury.

• Barium swallow: To assess damage.

Chemical Burns

1. Manifestations (MSO)

2. Diagnostic Test

• __: To determine the extent and severity of injury.

• __: To assess damage.

chemical burns

MEDICAL MANAGEMENT

            •           Immediate treatment for shock, pain, and respiratory distress.

            •           NPO (nothing by mouth); IV fluids are given.

            •           Avoid vomiting and gastric lavage (to prevent further exposure of the esophagus to caustic agent).

            •           Emergent esophagectomy or gastrectomy may be required in severe cases.

            •           After acute phase:

            •           Nutritional support via enteral or parenteral feeding.

            •           Dilation for strictures (may need repeated).

            •           If dilation fails → surgical reconstruction (esophagectomy with colon interposition).

NURSING MANAGEMENT

            •           Monitor for airway obstruction and respiratory distress.

            •           Provide emergency support for shock and pain.

            •           Maintain NPO status.

            •           Administer IV fluids and medications as prescribed.

            •           Assist with diagnostic procedures (esophagoscopy, barium swallow).

            •           Closely monitor for complications (perforation, infection, fistula formation, strictures).

            •           Provide nutritional support during recovery (enteral/parenteral).

            •           Offer emotional support (patients may be emotionally distraught).

            •           Educate family and patient on prevention (safe storage of caustic substances, childproofing at home).

1. corticosteroids

2. antibiotics

Pharmacologic Management (Chemical Burns)

1. __: Sometimes used to reduce inflammation and minimize scarring/stricture formation (value is questionable).

2. __: If documented infection is present.

Gastroesophageal Reflux Disease (GERD)

a disorder marked by backflow of gastric or duodenal contents into the esophagus, leading to troublesome symptoms and/or mucosal injury.

• CAUSE: Incompetent lower esophageal sphincter, Pyloric stenosis, Hiatal hernia, Esophageal motility disorders.

• Associated conditions: Irritable bowel syndrome (IBS), asthma, COPD, cystic fibrosis), Barrett’s esophagus (BE, Peptic ulcer disease, angina(differential)

• Lifestyle & risk factors: Tobacco use, Coffee drinking, Alcohol consumption, Gastric infection with Helicobacter pylori, Incidence increases with aging.

Pyrosis (heartburn), Regurgitation

Hallmark Symptoms for GERD

1. History taking

2. Ambulatory pH monitoring

3. PPI trial

4. Endoscopy

5. Barium swallow

Diagnostic Test (GERD)

1. __: Crucial for accurate diagnosis.

2. __ (gold standard) - Performed with transnasal catheter or endoscopic wireless capsule for ~24 hours.

3. __: Diagnostic tool.

4. __: To evaluate mucosal damage and rule out strictures/hernias.

5. __: Alternative for structural evaluation.

1. Avoid factors that decrease LES pressure or irritate esophagus, Tobacco cessation.

2. Proton Pump Inhibitors

3. H2 blockers, antacids, prokinetics

4. Nissen fundoplication

GERD

Medical Management

1. Lifestyle modifications: (AT)

Pharmacologic therapy:

2. __ (commonly used).

3. Other meds (H__, A__, P__) may also be considered

 

Surgical Management

4. __ (open or laparoscopic): Gastric fundus is wrapped around the sphincter area of the esophagus to reinforce closure and prevent reflux.

GERD

Nursing Management

            •           Educate patient on lifestyle modifications and medication adherence.

            •           Monitor for symptom relief and complications.

            •           Support patient pre- and post-surgery if fundoplication is performed.

            •           Reinforce long-term prevention strategies (smoking cessation, diet modification, weight management).

Barrett Esophagus

• is a condition in which the lining of the esophageal mucosa is altered, where the normal squamous epithelium is replaced by columnar epithelium (intestinal metaplasia).

• It is the only known precursor to esophageal adenocarcinoma (EAC), one of the fastest-rising cancers in Western populations.

• The 5-year survival rate for EAC does not exceed 20%.

• CAUSE: White men aged 50 or older,Family history of BE or esophageal adenocarcinoma (EAC), GERD (chronic reflux), Smoking, Obesity — Risk increases by 1.2% for each additional risk factor (cumulative effect).

1. Symptoms of GERD, especially frequent heartburn.

2. Symptoms of peptic ulcers.

3. Symptoms of esophageal stricture (e.g., dysphagia).

Manifestations (Barrett Esophagus)

Symptoms of G__, P__, E__

1. EGD (esophagogastroduodenoscopy)

2. Biopsy

Diagnostic Test (Barrett Esophagus)

1. __:

            •           Screening in patients with multiple risk factors.

            •           Shows esophageal lining that is pink (abnormal) instead of pale white.

2. __ (definitive diagnosis):

            •           Normal squamous mucosa replaced by columnar epithelium (metaplasia).

            •           Presence of goblet cells (intestinal metaplasia).

            •           Diagnosis if changes occur ≥1 cm above gastric folds.

1. endoscopic ablation techniques

2. 3-5 years

3. proton pump inhibitors (PPIs)

4. endoscopic resection

5. radiofrequency ablation

6. individualized

Medical / Endoscopic Management (Barrett Esophagus)

Monitoring: Varies depending on extent of cell changes.

(1)__: Can eliminate BE in up to 80% of patients, preventing progression to dysplasia.

Surveillance with biopsies:

If no dysplasia → repeat biopsy in (2)__ years.

(3)__: To control reflux symptoms.

Progression to dysplasia:

(4) E__

(5) R__ (high-frequency heat/cold energy to kill abnormal cells).

Treatment is (6)__

Barrett Esophagus

NURSING MANAGEMENT

• Reinforce adherence to PPI therapy and lifestyle modifications (smoking cessation, weight control, dietary adjustments).

• Support patient through surveillance programs (EGD + biopsy follow-ups).

• Provide information about the importance of early detection to prevent progression to EAC.

• Monitor for complications: worsening dysphagia, GI bleeding, weight loss.

• Educate patient on the relationship between GERD and BE.