Disorders of the Gastrointestinal System, 2nd Edition
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● H2 blockers reduce the amount of gastric acid production. ● Proton pump inhibitors (PPIs) block acid production. | NURSING ALERT Studies have shown that H2 receptor antagonists are effective for healing mild esophagitis but are less effective when the esophagus is eroded. More severe cases, or cases with esopha- geal erosion, may require using a PPI (Patti, 2021). A review of prescription and over-the-counter medications to identify possible drug interactions is important for patients who frequently use antacids. EVIDENCE-BASED PRACTICE Protein pump inhibitors (PPIs) limit gastric acid secretion and facilitate rapid resolution of symptoms and esophageal healing. Examples of ap- proved PPIs include Prilosec, Nexium, and Protonix. PPIs should be used only with a confirmed diagnosis of GERD. Chronic use has recently been shown to be associated with the fol- lowing conditions (Patti, 2021): ● Calcium homeostasis can be affected, increasing the risk for bone fracture, especially hip fractures in older adult women, and cardiac changes. ● Clostridium difficile infection. ● Iron, magnesium, and vitamin B12 malabsorption. ● Kidney disease (acute and chronic).
If treatment is unsuccessful, surgical op- tions for the treatment of GERD also exist. However, evidence is conflicting about whether surgery is an effective long-term solution. In a recent study reviewing the effectiveness of the surgical intervention fundoplication, 7.6% of those studied re- quired a revision of their original surgery, and 53.8% required anti-reflux medica - tions within six months of their surgery (Patti, 2021). Barrett’s esophagus In addition to helping patients adhere to their treatment regimen, nurses must be alert and teach their patients to be alert to the possibility of developing Barrett’s esophagus. Barrett’s esophagus is a dis- order characterized by normal tissue that lines the esophagus being replaced with tissue similar to the lining of the intestine, known as intestinal metaplasia (Spechler, 2022b). Barrett’s esophagus does not produce signs or symptoms. Its cause is unknown but often found in persons with GERD. The disorder affects up to 20% of adults age 50 and older in the U.S. It af- fects men about three times as often as women and White men more often than men of other ethnic backgrounds. Smok- ing also increases the risk of its develop- ment (Spechler, 2022b). According to one recent study by Kh- ieu and Mukherjee (2022), about 15% of those with GERD will develop Barrett’s esophagus. Because there are no specific signs and symptoms, physicians may rec- ommend that patients over age 50 with a lengthy history of GERD be screened for Barrett’s esophagus (Spechler, 2022b). A small percentage of patients with Barrett’s esophagus may develop esophageal ad- enocarcinoma. Because of the lack of symptoms, this cancer is often not detect- ed until it is advanced (Gibson, 2022).
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