A nurse is collecting data on a client who reports manifestations of gastroesophageal reflux disease (GERD). Which of the following manifestations should the nurse expect? (Select All that Apply.)

Brief Introduction: Gastroesophageal reflux disease involves the retrograde flow of gastric acid into the esophagus due to a compromised lower esophageal sphincter. This chronic exposure results in mucosal erosion, potential stricture formation, and extra-esophageal symptoms such as dental enamel decay and nocturnal laryngospasm. Rationale: A. Heartburn, or pyrosis, is the most common manifestation and occurs when gastric acid irritates the esophageal lining. This typically occurs 30 to 60 minutes after meals or when the client is in a recumbent position. B. Regurgitation is the effortless backflow of undigested food or sour liquids into the pharynx or mouth. It indicates that the lower esophageal sphincter is failing to prevent the upward movement of stomach contents during digestion. C. Dysphagia, or difficulty swallowing, can develop in chronic GERD due to the formation of esophageal strictures. Persistent inflammation leads to scar tissue buildup, which narrows the esophageal lumen and impedes the passage of food boluses. D. Hematochezia, or bright red blood in the stool, is indicative of lower gastrointestinal bleeding, typically from the rectum or colon. GERD can cause occult blood from esophageal erosions but it does not manifest as frank hematochezia. E. A chronic cough results from the micro-aspiration of gastric contents into the tracheobronchial tree, particularly during sleep. The acid acts as a chemical irritant to the laryngeal nerves, triggering a persistent, non-productive cough reflex. F. Wheezing and shortness of breath occur when refluxed acid causes bronchoconstriction or exacerbates underlying reactive airway disease. This extra-esophageal manifestation is often worse at night when the client is lying flat and gravity favors aspiration.