Pathogenesis of Gastro‐esophageal Re flux Disease

Discussion:

Luv Taub, a 32-year-old, married Hmong woman, presents to her primary care Nurse Practitioner complaining of a persistent burning sensation in her chest and upper abdomen. The symptoms are worse at night while she is lying down and after meals. She enjoys many years of cooking and eating “hot and spicy foods” common in her culture. She has tried drinking hot cocoa to help her sleep. She is a smoker and frequently relies on benzodiazepines for insomnia. She notes a sour taste in her mouth every morning. Physical examination is normal.Pathogenesis of Gastro‐esophageal Re flux Disease

In this discussion:

Discuss this patient’s likely diagnosis. Why do you support this “likely” diagnosis?

Describe the pathophysiology of this disorder.

Discuss a plan of care for this patient.

What is the anticipated prognosis for this patient? What lifestyle factors might alter her short- and long-term outcomes?

Include citations from the text or the external literature in your discussions. Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Discuss this patient’s likely diagnosis. Why do you support this “likely” diagnosis?

The “likely” diagnosis for this patient is gastroesophageal reflux disease (GERD). The patient complains of pain sensations on the chest and the upper abdomen where the esophageal sphincter is located. The patient also reports that the pain is exacerbated when she is lying down indicating possible leakage of gastric contents into the esophagus. The classic symptom of GERD is heartburn which is a burning sensation on the chest, radiating towards the mouth due to acid reflux from the stomach (Clarrett & Hachem, 2018).

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Describe the pathophysiology of this disorder.

The risk factors of GERD include smoking, anxiety, and eating spicy foods. One of the causes of GERD pain is due to the impaired mucosal defense against the acidic reflux into the esophagus. The breach of the mucosal barrier can be due to prolonged exposure to the gastric refluxate, medications such as benzodiazepines, and smoking (Argyrou et al., 2018). The gastric contents consist of hydrochloric acid and alkaline duodenal contents such as pancreatic enzymes that damage the mucosal layer.

Another cause of GERD is due to defective esophageal peristalsis. Gastric reflux into the esophagus is usually cleared by the esophageal peristalsis. However, impaired esophageal defense against the gastric contents damages the epithelial layer of the esophagus resulting in pain sensation (Clarrett & Hachem, 2018). The cause of impaired peristalsis may be as a result of transient lower esophageal sphincter relaxations.

Discuss a plan of care for this patient.

The patient should be assessed for alarm features which may prompt an urgent endoscopic evaluation. Although the long term care plan is lifestyle modification, the patient’s head of the bed (HOB) elevation should be changed to reduce esophageal exposure to gastric reflux. The patient should also be advised to minimize smoking and medications such as benzodiazepines which predispose her to GERD. Proton pump medications are potent antiacids that can be administered to the patient one hour before meals (Sandhu & Fass, 2018).Pathogenesis of Gastro‐esophageal Re flux Disease

What is the anticipated prognosis for this patient? What lifestyle factors might alter her short- and long-term outcomes?

The prognosis of GERD is usually good when the patient presents with a moderate case. However, poor response to drugs may lead to chronic cases that may require surgery. Lifestyle factors such as avoiding spicy foods would alter short term care. For long term care, she should be advised to practice smoking cessation (Clarrett & Hachem, 2018).

References

Argyrou, A., Legaki, E., Koutserimpas, C., Gazouli, M., Papaconstantinou, I., Gkiokas, G., & Karamanolis, G. (2018). Risk factors for gastroesophageal reflux disease and analysis of genetic contributors. World journal of clinical cases, 6(8), 176–182. https://doi.org/10.12998/wjcc.v6.i8.176

Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal Reflux Disease (GERD). Missouri medicine, 115(3), 214–218.

Sandhu, D. S., & Fass, R. (2018). Current Trends in the Management of Gastroesophageal Reflux Disease. Gut and liver, 12(1), 7–16. https://doi.org/10.5009/gnl16615 Pathogenesis of Gastro‐esophageal Re flux Disease