Gastroesophageal Reflux Disease (GERD) or Achalasia

Gastroesophageal reflux is passage of the gastric contents into the esophagus. It is considered a normal physiologic process occurs in healthy infants and children. However, when complications develop from the reflux of gastric contents back into the esophagus or oropharynx, it becomes more of a pathologic process known as gastroesophageal disease (GERD). If left untreated it will cause the esophagus to become enlarged and eventually stop functioning.

Diagnostic Evaluation:

  1. Barium Swallow – involves drinking a barium-containing liquid followed by an X-ray study to help identify structural changes in the esophagus, and is performed to evaluate any anatomic reasons for the symptoms the patient is experiencing.
  2. Esophageal manometry – which involves passing a small tube, or catheter, into the stomach to measure pressures along the esophagus can confirm a diagnosis of achalasia.

Signs and symptoms:

  1. Recurrent vomiting and regurgitation
  2. Weight loss or poor appetite
  3. Irritability in infants
  4. Chronic cough
  5. Wheezing
  6. Stridor
  7. Asthma
  8. Apnea
  9. Hoarseness
  10. Sore throat
  11. Halitosis (mostly in older children)
  12. Heartburn and chest pains
  13. Abdominal pain
  14. Hematemesis
  15. Dysphagia
  16. Chronic sinusitis
  17. Otitis media
  18. Poor dentition (caused by acid erotion)

Medical Management:

  1. Appropriate positioning such as elevating the head of the bed and keeping the infant or child upright for 30 minutes after feeding
  2. Smaller, more frequent feedings may be helpful
  3. Medications maybe prescribed to decrease the acid production and stabilize the pH of the gastric contents
  4. Nissen fundoplication  – the surgical approach that is done if GERD cannot be medically managed effectively or requires long-term medication
  5. Heller myotomy – a surgical treatment of choice. The lower esophageal sphincter muscle is cut so that food can pass easily from the esophagus into the stomach.
  6. Pneumatic dilation – a small balloon is passed under fluoroscopy to the esophageal sphincter and inflated. This expansion causes the lower esophageal sphincter muscle to stretch and weaken.
  7. Botox injection – Botox is injected into the lower esophageal sphincter to relax the muscle and allow food to pass more freely into the stomach.

Nursing Management:

  1. Assess the onset and progression of the symptoms
  2. Give infants smaller, more frequent feedings using a nipple that controls flow well.
  3. Thickening of the formula with products such as rice or oatmeal cereal can significantly help keep formula and gastric contents down
  4. Keep infant upright for 30 to 45 minutes after feeding
  5. Maintaining a patent airway.
  6. Assist in diagnostic procedures as well as surgical procedures prescribed.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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