GI & Endocrine
Pathophysiology of Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is a chronic disease because of retrograde masses of gastrointestinal fluid discharging to the esophagus, which leads to symptoms or damage to the mucosa. The dysfunction of the lower esophageal sphincter (LES) is the most prevalent pathophysiologic process that can be a temporary lower esophageal sphincter relaxation (TLESR), a reduction in LES tone, or morphologic abnormalities, including a hiatal hernia (Katz et al., 2022), when the process of refluxing of acidic substances of the stomach into the esophagus starts as a result of inadequately high pressure in the LES overcoming the defensive mechanisms against it, such as esophageal peristalsis and salivary buffering.
Acid exposure causes tissue injury to the esophageal mucosa, which causes inflammation or erosive esophagitis or morbidities, including Barrett’s esophagus. Acid and pepsin affect the integrity of the epithelia and activate esophagus chemoreceptors, which leads to heartburn and regurgitation symptoms (Katz et al., 2022). GERD is a widespread disease globally, and its prevalence is rising among most regions, which is causing a substantial burden and reduced quality of life worldwide (Dirac et al., 2020). Knowledge of these mechanisms aids in the early detection and proper management when dealing with clinical practice
Evidence-Based Diagnosis and Management (ACG 2022)
The American College of Gastroenterology (ACG) (2022) guideline claims that uncomplicated GERD can be diagnosed clinically, and patients who show common symptoms, including heartburn and regurgitation, without alarm features (Katz et al., 2022). First-line therapy should include an 8-week trial of a proton pump inhibitor (PPI) and should be taken once daily before meals. Endoscopy is implied in case of alarm symptoms, such as dysphagia, gastrointestinal bleeding, anemia, weight loss, or persistent vomiting.
Nonpharmacologic measures are highly advised and comprise loss of weight among overweight patients, head of the bed elevation, not taking food 2-3 hours before bedtime, and quitting tobacco (Katz et al., 2022). The change in diet must be made on a case-by-case basis, depending on the triggers of the symptoms. The pharmacologic management is mainly based on PPIs that are of better quality in their acid suppression and healing the mucosa than H 2 receptor antagonists. The minimum dose of therapy should be used, and it needs to be re-evaluated periodically (Katz et al., 2022).
Implications for Advanced Nursing Practice
Nurse practitioners (NPs) are important in giving a clear cut between the case of uncomplicated GERD and the one that needs referral. The patients who are sensitive to empiric PPI therapy and not alarming do not need urgent endoscopy. Nevertheless, the alarm symptoms, recurrent symptoms despite the best therapy, or the risk factors of the esophagus of Barrett make it necessary to refer to gastroenterology and potentially perform endoscopy (Katz et al., 2022). Since GERD (Dirac et al., 2020) is a global issue with a high and increasing incidence, advanced practice nurses should implement evidence-based practices to guarantee the prompt detection of complications and prevention of needless operations.
Patient Education and Adherence Strategies
Patient education is the key to adherence and outcomes improvement. The patients should be educated that they should take the PPIs 30-60 minutes before eating to reach their peak effect (Katz et al., 2022). Sustainable lifestyles change programs, in particular, weight management, are needed because obesity is a risk factor that can be changed to influence the occurrence and development of GERD (Dirac et al., 2020). Adherence is enhanced through follow-up visits, instructions, and assessments of realistic expectations. Patient-centered counseling and evidence-based management are the only ways in which nurse practitioners can reduce the symptom burden and eradicate the long-term complications.
References
Dirac, M. A., et al. (2020). The global, regional, and national burden of gastro-esophageal reflux disease in 195 countries and territories, 19902017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet Gastroenterology & Hepatology, 5(6), 561581.
Katz, P. O., et al. (2022). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology, 117(1), 2756.
Requirements: Make a Comment with references
Get this or a similar paper done in as fast as 4 hours, 24/7.
NB: We do not sell prewritten papers. All essays are written from scratch according to specific needs and instructions
Leave a Reply
You must be logged in to post a comment.