Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD)

Initial Post: Summarize the pathophysiology of Peptic Ulcer Disease as compared to GERD and explain which one his symptoms most closely represent. Support with evidence.

Peptic ulcer disease (PUD) is a “break or ulceration, in the protective mucosal lining of the lower esophagus, stomach or duodenum” (McCance & Huether, 2018). The hydrochloric acid build up causes erosions, which damages the superficial layer of the mucosa. Overtime through continuous erosion, ulcers will extend through the muscularis mucosae and damage blood vessels, causing hemorrhage or perforating the gastrointestinal wall. According to McCance & Huether (2018), “risk factors for peptic ulcer disease include genetic predisposition, H. pylori infection of the gastric mucosa, and habitual use of aspirin and NSAIDs.”

In contrast, Gastroesophageal Reflux Disease (GERD) is identified by the backflow of acid and pepsin or bile salts from the stomach to the esophagus. The esophagus then becomes inflamed which is known as esophagitis. This movement of acid, pepsin, and bile salts from the stomach to the esophagus is facilitated by way of irregularities in the functioning of the lower esophageal sphincter (LES). The weakness or loosening of the LES allows reflux of stomach contents into the esophagus (McCance and Huether, 2018). According to Cheng et al. (2021), “risk factors in GERD include obesity, pregnancy, smoking, hiatal hernia and specific drugs, including antihistamines, calcium channel blockers, antidepressants, and sedatives that medicine help sleep.”

I believe this patient has symptoms of GERD but overall has more symptoms pertaining to PUD. It does state that the patient has an occasional dry cough at night and according to Cheng et al. (2021), “recent reviews on the epidemiology examines that GERD have different levels of causality about asthma, chronic dry cough, sleep apnea, non-cardiac chest pain, chest tightness, and chronic bronchitis.” The patient described in the case study takes aspirin daily and drinks beer daily, which are major risks factors and can lead to the development of peptic ulcers. In addition, he complains of epigastric burning weight loss, which are all symptoms of PUD. H. Pylori is a gram negative bacteria which is common in the development of PUD. H. Pylori causes increase in gastrin that promotes acid secretion and disturbs gastrointestinal motility. According to Salsabila et al. (2021), “patients with positive H. pylori complained of fullness, early satiety, epigastric pain or burning, nausea, persistent or occasional vomiting, loss of appetite, and frequent burping.”

References

Cheng, Y.-H., Tung, T.-H., Chen, P.-E., & Tsai, C.-Y. (2021). Risk of incident gastroesophageal reflux disease (GERD) in patients with sleep disorders: a population-based cohort study. Sleep & Biological Rhythms, 19(1), 5–11. https://doi-org.su.idm.oclc.org/10.1007/s41105-020-00282-w

McCance K., L., & Huether, S., E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.

Salsabila Budiman, G. T., Begawan Bestari, M., & Suryanti, S. (2021). Clinical and endoscopic features in helicobacter pylori infection: Literature review. Indonesian Journal of Gastroenterology, Hepatology & Digestive Endoscopy, 22(1), 66–72. https://doi-org.su.idm.oclc.org/10.24871/221202166-72

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