Gastroesophageal reflux disease (GERD)

Nursing, Jul 2004 by Rayhorn, Nancy

What is GERD?

Short for gastroesophageal reflux disease, GERD causes heartburn and other problems, such as chest pain, nausea, and coughing, after you eat. These problems happen when food or liquid in your stomach goes the wrong way and travels up your esophagus instead of staying in your stomach.

Normally, food passes from your mouth down your esophagus into your stomach. A muscle where your esophagus and stomach meet keeps food in your stomach. But if you have GERD, the muscle sometimes opens at the wrong times, letting food and stomach acid into your esophagus. This causes heartburn, coughing, and other symptoms.

How will my health care provider know I have GERD?

First, shell ask you many questions about your health and your symptoms. She'll ask you to describe your symptoms and what triggers them. She'll also want to know how long symptoms last and what makes them go away. She'll probably diagnose GERD based on your symptoms. You won't need tests unless you have symptoms that don't improve with treatment. Then your health care provider may order one or more of these tests:

* Barium upper gastrointestinal radiography (X-ray). You'll be asked to drink a chalky-tasting liquid containing barium, which coats your esophagus and stomach so they show up on X-ray. A technologist will take X-rays of your esophagus, stomach, and small intestine. This test may last several hours.

* Esophagogastroduodenoscopy with biopsies. Your health care provider will place a flexible tubelike instrument called an endoscope down your throat. Shell use it to take pictures of your esophagus and stomach and may use it to take small samples of tissue. You'll receive medicine to keep you relaxed during the test, which lasts 30 to 60 minutes.

* Esophageal pH monitoring. To find out how often and for how long stomach acid enters your esophagus, your health care provider passes a thin tube through your nose or mouth and into your esophagus. The tube is attached to a small monitor that tracks the acid in your esophagus. You'll wear the monitor for 1 day and then return to your health care provider's office to have the tube removed and return the monitor.

Another tool for measuring stomach acid consists of a small capsule that can be attached to the lining of your esophagus. Your health care provider will place the capsule using a long wire, which she'll remove once the capsule is in place.

How is CERD treated?

Your health care provider will suggest lifestyle changes and medications to treat your GERD (see How Does My GERD Medicine Help Me?). Here are some of the lifestyle changes to treat GERD:

* If you're overweight, talk with your health care provider about a diet and exercise plan to lose weight.

* Sleep with the head of your bed raised 4 to 8 inches (10 to 20 cm). You could place a wedge under your mattress or put bricks under the bedposts. Using extra pillows may not help.

* Eat small meals more often, rather than several big meals.

* Drink plenty of water when you take medicine to make sure it goes into your stomach.

* Avoid chocolate, caffeine, peppermint, citrus fruits, tomato products, fatty foods, alcohol, and tobacco products because they can cause heartburn.

* Don't lie down for at least 3 hours after eating a meal.

* Don't eat or drink for 2 to 3 hours before bedtime.

If lifestyle changes and medicine don't help you feel better, your health care provider may suggest an endoscopic procedure or surgery. Endoscopie procedures use a tube inserted down the esophagus to tighten the muscle between the esophagus and stomach. A common type of surgery to correct GERD, called fundoplication, can be performed with an incision in your belly or by using a laparoscope (a device with a small camera on the end). The surgeon will place stitches in the top of the stomach to tighten the area between the esophagus and stomach. If she uses a laparoscope, she'll make only two tiny incisions, and you'll probably be in the hospital for 1 to 3 days. If you have to have the larger incision, you'll be in the hospital a little longer.

BY NANCY RAYHORN, RN, CGRN, BSN

Gastroenterology Clinical Scientist

Centocor, Inc., Phoenix, Ariz.