A nurse is caring for a client who has been diagnosed with gastroesophageal reflux disease (GERD). Which of the following should the nurse reinforce in the teaching as potential complications associated with poorly managed GERD? (Select All that Apply.)

Brief Introduction: Gastroesophageal reflux disease involves the retrograde flow of gastroduodenal contents into the esophagus due to lower esophageal sphincter incompetence. Chronic exposure to gastric acid induces mucosal inflammation, potentially leading to metaplastic transformation of squamous epithelium into columnar cells, known as intestinal metaplasia, which increases malignancy risks. Rationale: A. Chronic exposure to hydrochloric acid and pepsin causes direct denudation of the esophageal mucosa. This results in painful ulcerations, bleeding, and significant tissue friability within the lumen. Frequent endoscopic monitoring is often required to assess the severity of these inflammatory lesions and ensure healing. B. Barrett's esophagus represents a serious metaplastic change where the normal stratified squamous epithelium is replaced by simple columnar epithelium. It is a direct result of chronic acid insults and serves as a precursor to esophageal adenocarcinoma. Routine surveillance biopsies are mandatory for patients displaying these cellular alterations. C. Regurgitated gastric contents can bypass the epiglottis and enter the tracheobronchial tree, especially during recumbency. This leads to pulmonary inflammation and bacterial infection known as macro-aspiration. Patients often present with nocturnal cough, wheezing, and recurring lower respiratory infections due to micro-aspiration. D. Peptic ulcer disease typically involves the stomach or duodenum and is primarily caused by Helicobacter pylori or NSAID use. GERD involves acid but is a separate pathological process occurring above the gastroesophageal junction. PUD is not considered a direct complication of lower esophageal sphincter dysfunction. E. Persistent inflammation and subsequent healing cycles lead to the deposition of fibrous scar tissue within the esophageal wall. Collagen buildup causes narrowing of the lumen, resulting in progressive mechanical dysphagia. Dilatation procedures are often necessary to restore the diameter of the esophageal passage. F. Although GERD significantly increases the risk of esophageal adenocarcinoma, it is not a primary causative factor for gastric malignancy. Stomach cancer is more closely linked to chronic atrophic gastritis and specific dietary carcinogens. The pathological focus of GERD remains localized to the esophagus and airway.