Gastro-oesophageal reflux disease (GORD)
GORD is not a disease but rather a syndrome. The term GORD is defined as: any clinically significant symptomatic condition or histopathological alteration presumed to be secondary to reflux of the gastric contents into the lower oesophagus. It is the most common upper GI problem seen in adults, with approximately 5-7% of the population experiencing GORD. There is no single cause of GORD, several factors can be involved: dysfunction of the lower oesophageal sphincter (LOS), delayed gastric emptying, reflux of gastric contents, defective mucosal defence, and impaired oesophageal motility.
Complications of GORD are related to the direct local effects of gastric acid on the oesophageal mucosa. Oesophagitis (inflammation of the oesophagus) is a common complication of GORD. Repeated exposure may cause scar tissue formation, oesophageal stricture and dysphagia. Barrett’s oesophagus (oesophageal metaplasia) is a precancerous lesion that approximately 10-15% of patients with chronic reflux develop. These patients are at risk of oesophageal cancer and therefore will need to be monitored every 1-3 years by endoscopy and biopsy. Other complications of GORD include respiratory complications due to either the irritation of the upper airway by gastric secretions or aspiration of gastric secretions into the respiratory system. These include: bronchospasm, laryngospasm, asthma, chronic bronchitis, and pneumonia.
Nursing interventions of GORD mostly involve patient education.
- The patient’s head of the bed should be elevated 30 degrees as gravity assists with gastric emptying
- The patient shouldn’t lie down 2-3 hours after eating
- If the patient smokes they should be encouraged to quit as smoking causes an almost immediate drop in LOS pressure and decreases the ability to clear acid from the oesophagus
- If needed the patient should be encouraged to lose weight as obesity raises the intra-abdominal pressure, therefore overtaking the resting pressure of LOS
- Encourage the patient to eat small frequent (high protein, low fat) meals
If the patient requires surgery regular postoperative nursing care is provided. This entails:
- Prevention of respiratory complications via deep breathing exercises
- Maintenance of fluid and electrolyte balance via IV fluids, diet and fluids as ordered
- Prevention of infection
- Patient comfort