Gastroesophageal Reflux is Normal for Infants, Children, and Adults

Definition
Gastroesophageal reflux is considered a normal physiological process in healthy infants, children and adults. Most episodes last less that 3 minutes and most occur 30-60 min after meals and with reclining positions. GERD is present when the symptoms, more than twice a week, cause troublesome symptoms or complication (Cash, 2011, pp. 200). These complications can occur with severe, frequent, and persistent acid reflux causing inflammation, ulcers, and scarring. GERD can also lead to changes in the cells lining the esophagus, known as Barrett's esophagus, these changes raise the risk of esophageal cancer.
Pathogenesis
GERD is relaxation or incompetence of the lower esophagus persisting beyond the newborn period. Relaxation of the lower esophageal sphincter (LES) allows reflux of gastric acid and pepsin into the distal esophagus. Heartburn occurs when reverse peristaltic waves cause regurgitation of acidic stomach contents into the esophagus.

People at risk for GERD
GERD is very common. Daily heartburn typically occurring postprandially has been estimated to affect 17%-65% of the normal adult population. Regular heartburn is more common in smokers, pregnant women, heavy drinkers, those who are overweight, and those aged between 35 and 64 years. Reflux esophagitis affects over 50% of women at sometime during pregnancy. It is estimated that 30%-90% of asmatics have GERD. Barrett's oesophagus, which affects fewer than 1% of adults is commonly associated with GERD. (Cash, 2011, pp. 200).
Predisposing Factors to GERD include:
a) Obesity
b) Consuming large meals
c) Pregnancy
d) Emotional stress
e) Immature sphincter in newbornincreased abdominal pressure from tight clothes, staining to lift or defecate or swallowing air
f)...

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...ficulty dysphagia This indicate serious complication and risk for oesophageal cancer.
Weight changes Unintentional weight loss Could be because of difficulty swallowing caused by cancer
Overall appearance- hair, skin colour, face dehydration Due to difficulty swallowing or excessive vomiting
Signs of pregnancy

specific things the nurse would Ausculate anticipated observations Rationale
Lungs evaluate the presence of wheezing heart Abdomen in all four quadrants

specific things the nurse would Palpate anticipated observations Rationale
Abdomen for the presence of hepatosplenomegaly and masses.
Palpate for tenderness and masses

http://www.health.harvard.edu/fhg/doctor/GERD.shtml http://www.patient.co.uk/health/acid-reflux-and-oesophagitis Cash, J. C., & Glass, C. A. (2011). 10. Family practice guidelines (2nd ed., pp. 200-201). New York: Springer.