Gastroesophageal Reflux (GERD)


The regurgitation of gastric contents back up into the
esophagus. It is the result of relaxation or
incompetence of the lower esophageal neuromuscular
function or incompetence of the lower esophageal
(cardiac) sphincter. It occurs at any time and is not
necessarily related to having a full stomach.
Some “spitting up” is normal in infants because of
weakness in the esophageal (cardiac) sphincter. If
regurgitation continues and increases in frequency it
can be considered reflux.
Gastroesophageal Reflux (GERD)
ETIOLOGY & PATHOPHYSIOLOGY:
 Exact cause is unknown, but it is believed to
be a result of delayed maturation of the lower
esophageal neuromuscular function or
impaired hormonal control mechanisms.
 Repeated reflux (backward flow) of gastric
contents can damage delicate esophageal
mucosa.
GERD

GERD in children is usually self-limiting and
resolves spontaneously by age the age of 1
year. Treatment depends on the severity of the
condition. Some children only require a
modification of feeding habits, thickening of
feedings with rice cereal (controversial, this
recommendation changes constantly),
treatment with cholinergics, antihistamines,
antacids and histamine antagonists (pepcid,
zantac, tagamet, reglan, propulsid, maalox).
GERD

In severe cases (if child is aspirating stomach
contents and gastric fluid in to lungs) child
may require surgery, this surgical procedure is
called a Nissan fundoplication, in which the
gastric fundus (the greater curvature of the
stomach) is wrapped around the distal
esophagus. Postoperatively after a Nissan the
child will have a gastrostomy tube in place for
approximately 6 weeks post op.
Nursing Assessment - GERD
Assessment
 Frequent vomiting with bloody vomitus
 Hiccupping
 Aspiration and frequent respiratory infections
 Recurrent otitis media
 ALTE
 Cyanotic episodes
 Anemia secondary to blood loss.
The most important Nursing intervention is to
prevent aspiration
Nursing Interventions - GERD
Nursing Interventions:
 Treatment and nursing intervention depends on the severity
of disease.
 Strict I&O
 Document Amt, frequency, characteristics of Vomitus,
 Small frequent feedings
 Thicken formula with RC (if ordered)
 Place child at 30 – 45 degree angle after feedings
 Avoid citrus fruits & juice
 Family education
GERD
The most important
Nursing intervention
is to prevent
Aspiration.