Gastroesophageal Reflux Disease (GERD) in Adults

Jacqueline RodgersNR511: Differential Diagnosis and Primary Care Practicum Chamberlain College of Nursing July 2018

Incidence, Prevalence & Risk Factors

Disease Overview Gastroesophageal Reflux Disease, commonly known as GERD, is a chronic condition where stomach acid frequently flows back into the esophagus, leading to irritation. This condition is highly prevalent in North America, with a prevalence rate ranging between 18.1% and 27.8%. The incidence of GERD is approximately 5 per 1,000 persons annually. Several factors increase the likelihood of developing GERD, including:

• Obesity: Excess body weight, particularly around the abdomen, increases the pressure on the stomach, which can cause acid to back up into the esophagus.
• Age: The risk of GERD increases with age due to the weakening of the lower esophageal sphincter (LES) and slower gastric emptying.
• Pregnancy: Hormonal changes and increased abdominal pressure during pregnancy can lead to GERD.
• Hiatal Hernia: A condition where part of the stomach pushes up through the diaphragm, contributing to the weakening of the LES.
• Medications: Certain medications, such as NSAIDs, calcium channel blockers, and antidepressants, can relax the LES or irritate the esophagus, leading to GERD (El-Serag, Sweet, Winchester & Dent, 2014; NIDDK, 2014).

Pathophysiology

Disease Mechanism GERD results from a combination of factors that compromise the function of the LES, the muscle responsible for preventing stomach contents from flowing back into the esophagus. The key components of the pathophysiology include:

• Impaired Lower Esophageal Sphincter (LES) Function: The LES may become weak or relax inappropriately, allowing acid and food to reflux into the esophagus.
• Hiatal Hernia: This condition further weakens the LES by disrupting the normal anatomy of the stomach and esophagus.
• Obesity: Increased intra-abdominal pressure associated with obesity can worsen reflux.
• Impaired Esophageal Emptying: Delayed clearance of acid from the esophagus can lead to prolonged exposure to stomach acid, exacerbating symptoms (Tack, Pandolfino, 2018).

Additionally, GERD may be influenced by lifestyle factors such as diet, smoking, and alcohol consumption, which can aggravate the condition by weakening the LES or increasing acid production.

Clinical Presentation

Signs & Symptoms The clinical manifestations of GERD can vary in severity but often include:

• Heartburn: A burning sensation in the chest that typically occurs after eating and may worsen at night.
• Chest Pain: This pain can sometimes mimic that of a heart attack, making diagnosis challenging.
• Dysphagia: Difficulty swallowing, which may be due to esophageal inflammation or strictures.
• Regurgitation: The sensation of acid or food backing up into the throat or mouth, often accompanied by a sour or bitter taste.
• Chronic Cough: Persistent coughing that is not related to other respiratory conditions.
• New or Worsening Asthma: GERD can exacerbate asthma symptoms, especially at night.
• Disrupted Sleep: Nighttime reflux can lead to sleep disturbances, including waking up with a cough or a choking sensation.

Additional Considerations:

• Laryngopharyngeal Reflux (LPR): A subtype of GERD where acid reaches the throat and voice box, causing symptoms such as hoarseness, throat clearing, and a sensation of a lump in the throat.
• Complications: Chronic GERD can lead to complications such as esophagitis, Barrett’s esophagus, and an increased risk of esophageal cancer.

Managing GERD requires a comprehensive approach that includes lifestyle modifications, medication, and, in some cases, surgery. Identifying and addressing the underlying risk factors and pathophysiological mechanisms is crucial in effectively managing the condition.