Management of GORD

The first-line nursing of patients with GORD should relate to behaviour modification and nurses should encourage the following recommendations:

• avoidance of tight-fitting garments

• avoidance of dietary items which the patient finds worsens symptoms

• elevation of the bed-head in those who experience nocturnal symptoms

• avoidance of late meals

• cessation of smoking

Antacids, which are said to produce a protective mucosal 'raft' over the oeso-phageal mucosa, are taken with considerable symptomatic benefit by most patients. H2 receptor antagonist drugs, which reduce gastric acid secretion, help symptoms without healing oesophagitis. They are well tolerated and the timing of medication and dosage should be tailored to individual need.

Proton pump inhibitors are the treatment of choice for severe symptoms and for complicated reflux disease. These drugs irreversibly inhibit the proton pump, reducing the transport of hydrogen (H+) ions out of parietal cells. Symptoms almost invariably resolve and oesophagitis heals in the majority of patients. Recurrence of symptoms is almost inevitable when therapy is stopped, and some patients require lifelong treatment.

Patients who fail to respond to medical therapy, those who are unwilling to take long-term proton pump inhibitors and those whose major symptom is severe regurgitation are considered for anti-reflux surgery.

Evidence-based guidelines for the management of GORD have been published by the Scottish Intercollegiate Guidelines Network (SIGN) (2003) and the British Society of Gastroenterology (BSG) (2002).

Mallory-Weiss tear

A Mallory-Weiss tear is a mucosal tear at the gastro-oesophageal junction. It is associated with complications of GORD, prolonged forceful vomiting, alcohol abuse and trauma. Typically patients present with vomiting of bright red blood. The amount of blood lost is usually fairly small and these patients are generally treated conservatively, allowing the bleeding to stop spontaneously. Profuse bleeding may require to be controlled endoscopically using a coagulating heater probe.

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