Concept Map Template-Diagnosis- Gastroesophageal Reflux Disease (GERD)

·        Weak LES

·     Increased weight gain and obesity, especially around the stomach, which increases abdominal pressure.

·     Pregnancy leads to a rise in abdominal pressure and chemical changes in the body.

·     Hiatal hernia (Fuchs et al., 2021)

·     Insufficient esophageal motility (Fuchs et al., 2021)

·     Genetic conditions such as scleroderma which may affect how LES-related muscles function, including muscle relaxation.

·     Poor lifestyles such as smoking, drinking alcohol, and eating fatty fast foods

·   Heartburn

·   Regurgitation

·   Esophageal chest pain

·   Difficulty in swallowing

·   Persistent dry cough

Chronic exposure to gastric acid and refluxate results in chronic irritation and inflammation of the esophageal lining. This eventually causes damage to the esophageal lining.

The chronic irritation and inflammation of the esophageal lining can lead to various complications in the long term, such as:

·     Reflux esophagitis

·     Narrowing and tightening of the esophagus leading to swallowing problems

·     Barrett’s esophagus

·     Esophageal cancers such as esophageal adenocarcinoma

·     Esophageal lesions

·     In cases of micro-aspiration of gastric contents beyond the esophagus into the laryngopharynx, GERD can cause ear, nose, and throat damage and associated complications  (Tack & Pandolfino, 2018).

·     People with GERD can inhale stomach acid into the lungs, especially when lying down, which can lead to persistent cough and reoccurring respiratory infections with asthma-like manifestations such as breathing difficulties.

·     Gastrointestinal symptoms associated with GERD lead to dissatisfaction with daily life activities, including eating and a low quality of life (Isshi et al., 2021).

·         Peptic Ulcer Disease (PUD), which has similar symptomatic presentations to GERD, including heartburns, breathing difficulties, and regurgitation or vomiting. PUD can be differentiated from GERD based on the time and circumstances under which symptoms are presented, such as symptoms occurring when having an empty stomach.

·         Gastritis is also a potential diagnosis, which can be evidenced by the presence of repeated acid reflux and heartburn after eating, as well as abdominal and chest pain. However, both can be differentiated by affected areas, as gastritis involves the inflammation of the stomach lining, while GERD involves the esophageal lining.

·         Heart attack, which can also be evidenced by altered heart rate, blood pressure, and tissue perfusion, is also manifested by chest pain mimicking GERD-related chest pain. Both can be differentiated based on underlying triggers.

·          Upper Endoscopy to visually assess inflammation in the esophageal lining and deformations in the lining or on the LES.

·          Ambulatory acid (pH) probe test to monitor acidity levels in the esophagus and the duration of acidic refluxes due to gastric acid and refluxate from the stomach

·          Esophageal manometry to test for the coordination within esophageal muscles during swallowing.

·          Trans-nasal esophagoscopy for video- and photo-aided inspection of the esophagus for any injuries and damage due to acid refluxes

Medications for GERD include:

·         Omeprazole is a proton pump inhibitor (PPI), which is effective in reducing stomach acid production, therefore providing GERD-related acid reflux symptom relief. The recommended dosage is to begin with 60mg, to be taken orally once daily, and to be increased to a maximum of 360mg a day based on symptoms.

·         Famotidine, an H-2 receptor blocker, which provides prolonged relief to GERD-related acid reflux and heartburns. Famotidine dosage is 20mg, to be taken orally every 6 hours.

The possible referrals include:

·         Referring the patient to a gastroenterologist to help conduct a more detailed evaluation of the patient, including presented symptoms as well as interpretation of the diagnostic test results.

·         A dietician to provide informed dietary advice on the foods to eat and to avoid during and after the treatment.

·         A physical health specialist, including a gym instructor, to help the patient manage their weight.