(^302) Medical-Surgical Nursing Demystified
lower esophageal sphincter. The pain due to acid refluxing into the esophagus is
worse after eating or when lying down. Patients with a hiatal hernia may also
experience reflux due to the increased pressure that exists from a portion of the
stomach protruding upward through the diaphragm.
PROGNOSIS
Control of symptoms is possible through lifestyle modification and use of med-
ications to reduce acid production within the stomach. There has been no correla-
tion shown between the severity of patient symptoms and the degree of damage
being done to the tissue of the esophagus. Patients with ongoing symptoms should
have an upper endoscopy to allow for visualization and biopsy of the area to mon-
itor for the possibility of cancer of the esophagus developing due to long-term
reflux. Barrett’s esophagus is a premalignant condition of the esophagus that
occurs due to reflux, where cellular changes have occurred and the patient needs
to be monitored for progression to a malignant cell type. Some patients may
develop trouble with swallowing due to the development of scarring from long-
term exposure to acid. These patients may develop strictures over time. Procedures
can be performed to help stretch the lumen of the esophagus to aid in swallowing.
HALLMARK SIGNS AND SYMPTOMS
- Epigastric burning, worse after eating
- Heartburn
- Burping (eructation) or flatulence
- Sour taste in mouth, often worse in the morning
- Nausea
- Bloating
- Cough due to reflux high in the esophagus
- Hoarseness or change in voice
INTERPRETING TEST RESULTS
- 24-hour pH monitoring of lower esophageal area will show elevations.
- Barium swallow or upper GI study may show reflux.