GERD - Gastroesophageal Reflux Disease Clinical Practice

GERD- Gastroesophageal Reflux Disease Clinical Practice

The presentation focuses on Gastroesophageal Reflux Disease (GERD), emphasizing current treatment recommendations from accepted professional organizations. GERD is a common gastrointestinal disorder characterized by the reflux of stomach contents into the esophagus, causing symptoms such as heartburn, regurgitation, and chest discomfort. Its management requires an evidence-based approach that includes lifestyle modifications, pharmacologic therapy, and, in some cases, surgical interventions. Adhering to current clinical guidelines ensures optimal patient outcomes, minimizes complications, and aligns nursing practice with the latest standards.

Current clinical practice guidelines for GERD management are primarily provided by organizations such as the American College of Gastroenterology (ACG) and the American Gastroenterological Association (AGA). These guidelines underscore the importance of a comprehensive assessment that involves detailed patient history, symptom evaluation, and diagnostic testing as needed. The initial management of GERD emphasizes lifestyle modifications including weight loss, dietary adjustments, elevating the head of the bed, and avoiding trigger foods such as fatty meals, caffeine, and alcohol. These non-pharmacologic measures serve as foundational interventions to reduce symptom severity and improve quality of life.

Pharmacologic management remains central to GERD treatment, with proton pump inhibitors (PPIs) being the first-line medication prescribed for frequent and severe symptoms. PPIs, such as omeprazole and esomeprazole, effectively suppress gastric acid production and promote mucosal healing. The guidelines recommend daily PPI therapy for 8 to 12 weeks with possible dose adjustments based on response. For patients with mild, intermittent symptoms, histamine-2 receptor antagonists (H2RAs) like ranitidine may be sufficient, but their use is generally limited due to the availability of more effective PPIs.

In cases where medication therapy fails or complications such as esophageal erosions, strictures, or Barrett’s esophagus develop, further diagnostic and therapeutic procedures are indicated. Esophageal pH monitoring and manometry are valuable diagnostic tools to assess acid exposure and esophageal motility, respectively. Surgical options, such as laparoscopic fundoplication, are considered for refractory cases or when patients prefer a definitive solution. Emerging therapies like magnetic sphincter augmentation show promise but require further validation through clinical trials.

Maintaining updated knowledge is essential for healthcare providers managing GERD. Nursing role involves patient education on medication adherence, lifestyle modifications, recognition of alarm symptoms (e.g., dysphagia, weight loss, anemia), and coordinating multidisciplinary care to optimize outcomes. Evidence indicates that an integrated approach combining pharmacotherapy with patient-centered education effectively reduces symptom burden and prevents complications. Continual review of recent literature and guideline updates ensures practice remains aligned with current standards, ultimately enhancing patient safety and care quality.

References

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• American College of Gastroenterology. (2018). GERD guidelines: Practice guidance. Gastroenterology Practice. https://gi.org/guideline/gerd/
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