GENERAL OBJECTIVE: On completion of the seminar students will acquire in depth knowledge regarding gastroesophageal reflux disease, gain skills in identifying & managing the conditions and develop a positive attitude about nurse's role.
SPECIFIC OBJECTIVES: On completion of seminar students will be able to * Define gastro oesophageal reflux disease
* Enlist the risk factors for GERD
* Explain the pathophysiology of GERD
* List down clinical manifestations GERD
* Describe the management of GERD.
* Enlist the complications of GERDINTRODUCTION
Gastro oesophageal reflux disease is a common, lifelong condition that requires long term treatment. GERD is the most common upper GI problem seen in adults. Some degree of gastro oesophageal reflex is normal in both adults & children. Excessive reflux may occur because of an in competent lower oesophageal sphincter, pyloric stenosis or a motility disorder. Many patients have (NERD) Non erosive reflux disease show no sign of oesophageal inflammation. DEFINITIONS
1. Gastro oesophageal reflux disease is a condition in which gastric recreations reflux into oesophagus. (Linda s. William, 2003)
2. GERD entails the reflux of gastric & duodenal contents through the lower oesophageal sphincter (LES) into the oesophagus to cause symptoms or injury to oesophageal, oropharyngeal or respiratory tissues. (Neil R.Floch, 2010) 3. GERD is a heterogeneous syndrome resulting from oesophageal reflux. (Phipps, Monnahon, 2003)
4. GERD is a syndrome with clinically significant symptomatic condition or histopathology alteration secondary to reflux of gastric contents into the lower oesophagus. (Lewis, heitkemper,2004) INCIDENCE
GERD is a common disorder in adults. There are no documented genders or cultural patterns associated with reflux but older adults experience decreased esophageal peristalsis and a higher incidence of hiatal hernia which together increase the likelihood of reflux in this population. ETIOLOGY
There is no single cause of GERD .Several factors or combination of factors can be involved. It results when the defences of lower oesophagus are overwhelmed by the reflux of acid gastric contents into oesophagus. The LES is the anti reflux barrier. PREDISPOSING FACTORS:
* Hiatal hernia: which displaces LES into the thorax
* Incompetent LES
* Decreased oesophageal clearance resulting from impaired oesophageal motility or gastric motility( auto immune disorders, neuromuscular disease, endocrine disorders, DM) A number of environmental and physical factors appear to influence GERD such as: * Intake of fatty foods, chocolate ,coffee, cola, nicotine * Drugs such as calcium channel blockers, theophylline & possibly NSAIDs * Cigarette smoking
* Elevated levels of estrogen and progesterone
Condition that elevate intra abdominal pressure:
* Heavy lifting
Reflux is much more common after a meal. Genetic factors may also be considered. PATHOPHYSIOLOGY
Normally a high pressure zone exists in the region of gastric oesophageal sphincter (LES). High pressure prevents reflux but permits the passage of food and liquids. When there is relaxation of LES , pressure decreases and reflux of stomach contents into lower oesophagus occurs. Delayed gastric emptying may also contribute to reflux by increasing gastric volume and pressure. Decreased salivation & buffering from salivary bicarbonate may...
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