The reflux of stomach acid and contents into the esophagus. This typically causes
symptoms because the lining of the esophagus is not protected against the acid that
is normally found only in the stomach. The pain that is produced is often referred to
as heartburn, or may be mistaken for cardiac pain. The pain may also be referred
to the back. The pain occurs more frequently in men, people who are obese, smok-
ers, and those who use alcohol or medications that lower the muscle tone of the
lower esophageal sphincter. The pain due to acid refluxing into the esophagus is
worse after eating or when lying down. Patients with a hiatal hernia may also
experience reflux due to the increased pressure that exists from a portion of the
stomach protruding upward through the diaphragm.
PROGNOSIS
Control of symptoms is possible through lifestyle modification and use of med-
ications to reduce acid production within the stomach. There has been no correla-
tion shown between the severity of patient symptoms and the degree of damage
being done to the tissue of the esophagus. Patients with ongoing symptoms should
have an upper endoscopy to allow for visualization and biopsy of the area to mon-
itor for the possibility of cancer of the esophagus developing due to long-term
reflux. Barrett’s esophagus is a premalignant condition of the esophagus that
occurs due to reflux, where cellular changes have occurred and the patient needs
to be monitored for progression to a malignant cell type. Some patients may
develop trouble with swallowing due to the development of scarring from long-
term exposure to acid. These patients may develop strictures over time. Procedures
can be performed to help stretch the lumen of the esophagus to aid in swallowing.
SIGNS AND SYMPTOMS
• Epigastric burning, worse after eating
• Heartburn
• Burping (eructation) or flatulence
• Sour taste in mouth, often worse in the morning
• Nausea
• Bloating
• Cough due to reflux high in the esophagus
• Hoarseness or change in voice
TREATMENT
• Administer antacids to neutralize acid; these medications act quickly:
• Maalox, Mylanta, Tums, Gaviscon
• Administer H2 (histamine type 2) blockers to decrease the production of acid:
• ranitidine, famotidine, nizatidine, cimetidine
• Administer proton pump inhibitors to reduce the production of acid:
• omeprazole, esomeprazole, pantoprazole, rabeprazole, lansoprazole
• Have patient eat six small meals rather than three large ones to reduce intra-
abdominal pressure.
• Surgery or endoscopic procedures may be performed to prevent the reflux
from occurring.
NURSING DIAGNOSES
• Risk for imbalanced nutrition: less than what body requires
• Risk for imbalanced nutrition: more than what body requires
• Acute pain
• Chronic pain
NURSING INTERVENTION
• Monitor vital signs.
• Assess abdomen for distention, bowel sounds.
• Teach about medication management.
• Teach patient about lifestyle modifications:
• Not to lie down after eating.
• Elevate head of bed.
• Avoid wearing clothing that is tight at waist.
• Avoid acidic foods (citrus, vinegar, tomato), peppermint, caffeine, alcohol.
• Stop smoking.
• Lose weight if overweight
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