Gastroesophageal Reflux Disease.docx

Gastroesophageal Reflux Disease (GERD)  GERD is caused by gastric contents that enters the esophagus primarily due to the relaxation of the lower esophageal sphincter (LES).  The influx of chyme from the stomach into the esophagus results in inflammation leading to reflux esophagitis. It is typical...

Gastroesophageal Reflux Disease (GERD)  GERD is caused by gastric contents that enters the esophagus primarily due to the relaxation of the lower esophageal sphincter (LES).  The influx of chyme from the stomach into the esophagus results in inflammation leading to reflux esophagitis. It is typically caused by an incompetent LES, hiatal hernia, gastroparesis, and obesity. The LES plays a critical role in the development of GERD symptoms. In an LES defect, the decreased tone of the LES allows acid to flow from the stomach into the esophagus, which results in the burning sensation that patients report.  The worse the LES tone, the more reflux the patient will have. In examining the diagram below, the LES is not a true anatomical sphincter because there is no connection.  Instead it is composed of smooth muscles in the distal esophageal area that causes it to close and open during swallowing. When the LES opens repeatedly over a long period of time, stomach contents can enter the esophageal area leading to the symptomatic burning.  From the diagram to the right, you can see that LES sphincter is never fully closed with GERD. When evaluating a patient with GERD, the NP must consider the types of presenting symptoms. It is easy to evaluate typical GERD symptoms. But, with atypical and associated symptoms, the patient may not realize that these also reflect GERD.  The typical, atypical and associated symptoms are listed below.  Whether the symptoms are atypical or associated, all have heartburn and reflux in common.  **Typical Symptoms** - Heartburn: burning sensation in chest, often occurring after eating or at night-worsens when lying down or bending over - Regurgitation: sour or bitter-tasting fluid backing up into the throat or mouth - Dysphagia: difficulty swallowing