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Gastroesophageal Reflux Disease (GERD) Assessment

Girdle-girl with Assess-man
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GERD is the reflux of gastric contents into the esophagus, which is characterized by inflammatory symptoms resulting from the irritating effects of gastric or duodenal contents on the esophageal mucosa. Patients who are obese are at increased risk for the disease due to increased intra-abdominal pressure, which allows the reflux (backward flow) of stomach contents into the esophagus.
9 KEY FACTS
PATHOPHYSIOLOGY
Relaxed Lower Esophageal Sphincter
Relaxed Lower Sarcophagus Sphinx

Inflammation in this disorder causes persistent relaxation of the sphincter at the base of the esophagus. The LES typically constricts to prevent reflux of gastric contents into the esophagus. Chronic inflammation by prolonged GERD can lead to “Barrett's Esophagus/Epithelium,” which increases esophageal adenocarcinoma risk.

SIGNS AND SYMPTOMS
Dyspepsia (Indigestion)
Disc-pop

Dyspepsia is a condition of impaired digestion. It typically occurs after meals and includes symptoms such as abdominal pain/discomfort, bloating, nausea, heartburn, upper abdominal fullness, and belching. It is important to differentiate the characteristics of upper abdominal pain and chest pain in patients; there is often a correlation with dyspepsia and food intake.

Belching
Belching

Commonly gas in the stomach is held in place by the lower esophageal sphincter (LES). Since these patients have poor LES tone they often exhibit belching, which may be excessive after consuming gas-producing foods or beverages.

Nighttime Coughing
Nighttime Coughing Coffee-pot

Classically GERD is associated with symptoms that are worsened when lying down, like at night. This increased irritation causes coughing, wheezing, and dyspnea that may wake the patient from sleep. GERD can mimic asthma or can worsen pre-existing asthma. Patients should be advised to elevate the head of bed when sleeping.

Dysphagia
Dice-fajitas

The term dysphagia means difficulty swallowing and may be the result of esophagitis from GERD. Dysphagia also may be a presenting complaint of an esophageal stricture, which is a complication GERD. Swallowing may also be painful, termed odynophagia.

Epigastric Pain
E-pick-gas Pain-bolt

The pain in GERD is classically described as above the stomach and described by patients as a burning sensation that seems to rise up from the stomach in the center of their chest. The pain may persist in a wave-like motion. It often mimics angina-like pain but, typically in GERD, these patients have recently ingested a meal.

Regurgitation
Regurgitation

Reversal of food contents in the opposite direction is termed regurgitation. These food contents or stomach acid may lead to aspiration into the respiratory tract or vomiting.  Aspirated food contents are common causes of respiratory patients. Another phenomenon is called “water brash” where excess salivation occurs as a reaction to regurgitation. It can be described as that last feeling of salivation right before you vomit.

Heartburn (Pyrosis)
Heart-burning

Heartburn, also known by the medical term pyrosis, is the painful burning feeling below or behind the breastbone. The pain often rises in one’s chest from the stomach and may radiate to the neck, throat, or jaw region. This symptom is frequently experienced in patients with GERD.

Globus
Globe

Globus, sometimes referred to as globus pharyngis or globus hystericus, is the subjective feeling or sensation of a lump or foreign body in the throat. GERD is often a major cause of globus.

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