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:
- 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.
- 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:
- Recurrent vomiting and regurgitation
- Weight loss or poor appetite
- Irritability in infants
- Chronic cough
- Wheezing
- Stridor
- Asthma
- Apnea
- Hoarseness
- Sore throat
- Halitosis (mostly in older children)
- Heartburn and chest pains
- Abdominal pain
- Hematemesis
- Dysphagia
- Chronic sinusitis
- Otitis media
- Poor dentition (caused by acid erotion)
Medical Management:
- Appropriate positioning such as elevating the head of the bed and keeping the infant or child upright for 30 minutes after feeding
- Smaller, more frequent feedings may be helpful
- Medications maybe prescribed to decrease the acid production and stabilize the pH of the gastric contents
- Nissen fundoplication – the surgical approach that is done if GERD cannot be medically managed effectively or requires long-term medication
- 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.
- 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.
- 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:
- Assess the onset and progression of the symptoms
- Give infants smaller, more frequent feedings using a nipple that controls flow well.
- Thickening of the formula with products such as rice or oatmeal cereal can significantly help keep formula and gastric contents down
- Keep infant upright for 30 to 45 minutes after feeding
- Maintaining a patent airway.
- 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.
