The client with GERD complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions?
A. Development of laryngeal cancer.
B. Irritation of the esophagus.
C. Esophageal scar tissue formation.
D. Aspiration of gastric contents.
Correct Answer: D. Aspiration of gastric contents
Clients with GERD can develop pulmonary symptoms such as coughing, wheezing, and dyspnea that are caused by the aspiration of gastric contents. It is frequently thought that GERD plays a big role in chronic cough; there are reports that 25% or more of chronic cough cases are associated with GERD.
Option A: GERD does not predispose the client to the development of laryngeal cancer. The most intuitive theory is called the reflux theory, whereby reflux rises above the esophagus and upper esophageal sphincter, resulting in microaspiration as microdroplets land in the larynx or occasionally enter the bronchial tree, directly causing cough as a protective mechanism against reflux.
Option B: Irritation of the esophagus can develop as a result of GERD. However, GERD is more likely to cause painful and difficult swallowing. In the reflex theory, because of the common embryologic origin of the respiratory tract and the digestive tract, a little bit of reflux in the esophagus can lead to an esophagobronchial reflex that causes cough.
Option C: Esophageal scar tissue formation can develop as a result of GERD. GERD occurs in approximately 20% of Americans, and chronic cough is a very common problem, which patients with GERD are not immune to developing. Due to the baseline GERD rate of 20%, it is difficult to separate the presence of the disorder from the causative effect of the disorder.
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