Gastroesophageal Reflux Disease and Peptic Ulcer Disease

Gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) are often mentioned together because gastric acid contributes to both, but they are different disorders with different clinical priorities. GERD occurs when refluxed gastric contents produce troublesome symptoms—typically heartburn or regurgitation—or cause a complication. Acid and other gastric contents repeatedly contact the oesophageal mucosa, producing irritation and, in some patients, inflammation, narrowing, or metaplastic change such as Barrett’s oesophagus. PUD is a mucosal ulcer in the stomach or duodenum. The ulcer can cause pain, but its most dangerous consequence is erosion into a blood vessel, producing an upper gastrointestinal haemorrhage. That is why coffee-ground emesis, melena, syncope, or hypotension changes the situation from symptom management to resuscitation. The experienced nurse first sorts the presentation into one of three patterns: - Predominantly reflux: burning retrosternal discomfort and/or regurgitation, often recurring with meals or when lying down. - Possible ulcer disease: epigastric discomfort, nausea, or a history suggesting ulcer risk, especially when symptoms are persistent or recurrent. - Possible upper GI bleeding: coffee-ground or bloody vomit, black tarry stool, dizziness, pallor, tachycardia, orthostatic...