Primary Diagnosis Of Gastroesophageal Reflux Disease Discussion

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Primary Diagnosis Of Gastroesophageal Reflux Disease Discussion

  1. Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?
Pathophysiology of Primary Diagnosis
GERD is when there is esophageal lining irritation from the flow of bile and stomach acid back into the esophagus. The cardiac sphincter prevents the backflow normally by the mechanism of closing when the food gets into the stomach. When its muscles relax abnormally or are weak, there is an acid escape, resulting in inflammation from their corrosiveness. Repeated exposure to stomach acid results in ulcers, esophageal damage, and  Barrett’s esophagus, a condition that predisposes one to esophageal cancer (Maret-Ouda et al., 2020)Primary Diagnosis Of Gastroesophageal Reflux Disease Discussion.

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Causes Risk Factors (genetic/ethnic/physical)
Overeating

Being overweight

Alcohol consumption

Caffeine consumption

Smoking

Some foods like chocolate, citrus

Some medications, like (NSAIDS ) like ibuprofen.

 Obesity-Increases stomach pressure

Eating while lying

Pregnancy- hormonal changes relax the lower esophageal sphincter

Medication-NSAIDs irritate esophageal lining

Caffeine and alcohol consumption

Hiatal hernia- The stomach pushes through the diaphragm ((Maret-Ouda et al., 2020)Primary Diagnosis Of Gastroesophageal Reflux Disease Discussion.

 

 

  1. What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications?Primary Diagnosis Of Gastroesophageal Reflux Disease Discussion
Signs and Symptoms – Common presentation How does the diagnosis impact each body system? Complications?
Dysphagia-difficult swallowing.

Chest pain without heartburn.

Regurgitation.

Heartburn.

Sore throat.

A sensation of a lump in the throat.

Nausea.

 

 Digestive system– There is esophagitis, ulcers, and Barrett’s esophagus resulting from the reflux of stomach acid.

Cardiovascular system– The chest pain may be mistaken for angina.

Respiratory system- When the acid is aspirated into the lung, it causes conditions like asthma, chronic cough, pneumonia, and bronchitis. Also, chronic irritation from acid reflux can cause laryngitis and sore throat.

Nervous System– Acid reflux causes chronic irritation that can stimulate the vagus nerve and cause heart palpitations that could be mistaken for heart problems. There could be night disruptions as a result of regurgitation, discomfort, and coughing, which could amount to insomnia.

Immune system– The irritation causes the immune system response, resulting in inflammation. This weakens the lining of the esophagus over time, predisposing it to ulceration and infection.

Endocrine system- Hormones progesterone in pregnancy and leptin in obesity relax the lower esophageal sphincter, causing acid reflux.

Musculoskeletal system– Musculoskeletal pain resulting from chronic coughing.

The possible complications

Esophageal strictures– This is the narrowing of the esophagus from the scar formation after repeated healing and acid exposure of the esophagus.

Esophagitis– Inflammation of the esophagus.

Esophageal ulcers refer to open sore formation when the esophageal wall is eroded by stomach acid.

Barrett’s esophagus-  There is a tissue lining in the esophagus similar to the intestine’s lining because of acid irritation, and these individuals are predisposed to esophageal cancer.

Esophageal cancer– This mainly results from chronic GERD and Barrett’s esophagus.

Aspiration pneumonia- This occurs when the relaxed acid enters the lungs and causes infection.

 

  1. What are other potential diagnosis that present in a similar way to this diagnosis (differentials)?
Peptic ulcer disease (PUD)- These are sores that develop in the lower esophagus, small intestine, and stomach from stomach acid erosion. Mainly caused by nonsteroidal anti-inflammatory drugs (NSAIDs) and infection with Helicobacter pylori. Some similar signs include epigastric pain, nausea, and vomiting. The differences include relief of pain after eating, unlike in GERD, pain worsens after eating (Roman et al., 2022). Complications of PUD include perforation, bleeding, and gastric obstruction.

 

Angina-  It is chest pain that results from reduced blood flow to the heart muscles. Similar to GERD, it presents with chest pain. The chest pain in GERD mimics angina. Also, it worsens with activities, and thus, it is difficult to differentiate the two. Unlike GERD, angina chest pain is accompanied by dizziness, shortness of breath, and chest tightness (Ford & Berry, 2020). The GERD improves when antacid medications are administered, and angina does not improve on these medications.

 

Esophageal Motility Disorders- These are disorders that involve abnormal muscle contractions in the esophagus, thus making it difficult for liquids and food to get into the stomach. For example, achalasia, there is damaged nerve and thus the esophagus muscles cannot squeeze liquids and foods into the stomach. Similar to GERD, there is chest pain, dysphagia and regurgitation. Different form GERD is that there is non-acidic regurgitation and progressive dysphagia for both liquid and solid foods (Patel et al., 2022)Primary Diagnosis Of Gastroesophageal Reflux Disease Discussion.

 

  1. What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
Esophagogastroduodenoscopy (EGD)- To aid in the visualization of esophagus, stomach, and duodenum. The strictures, esophagitis, and Barrett’s esophagus are visualized to rule out the diagnosis. Helps to rule out esophageal cancer and peptic ulcer disease (Katzka & Kahrilas, 2020).

 

Esophagram (Barium swallow)- The swallowing of barium contrast helps in esophagus and stomach visualization. It confirms GERD by showing a barium reflex from the stomach into the esophagus (DeWitt et al., 2021).

 

Helicobacter pylori test – To detect the bacteria Helicobacter pylori that causes PUD. This is to help in ruling out PUD. It is done through biopsy, urea breath test, or stool antigen test.

 

24-hour Esophageal pH monitoring- It is done to account for the amount of acid refluxing for a day. It is done when the endoscopy is inconclusive, but GERD is suspected (Katzka & Kahrilas, 2020)Primary Diagnosis Of Gastroesophageal Reflux Disease Discussion.

 

 

  1. What treatment options would you consider? Include possible referrals and medications.
Lifestyle modification

It includes dietary changes like alcohol avoidance, weight management, smoking cessation, and head-of-bed elevation (Katzka & Kahrilas, 2020).

 

Medication

Proton pump inhibitors (PPIs). Example of esomeprazole and omeprazole blocks acid production final step. It is the first-line treatment for GERD.

Histamine-2 Receptor Antagonists (H2RAs). Examples include cimetidine and ranitidine. They act by reducing acid production by blocking stomach acid-producing cell’s histamine receptors (Chapelle et al., 2021)Primary Diagnosis Of Gastroesophageal Reflux Disease Discussion.

Antacids. Examples of magnesium hydroxide and calcium carbonate. They help neutralize stomach acid, thus relieving heartburn.

Prokinetics. Examples of metoclopramide and domperidone. They enhance gastrointestinal motility by increasing lower esophageal sphincter tone as well as hastening gastric emptying (Chapelle et al., 2021).

 

Referrals

Surgeon- For a failed medical therapy or if the patient requires surgery.

Gastroenterologist- This is when endoscopic evaluation is required for severe GERD, Barrett’s esophagus, and esophagitis. Primary Diagnosis Of Gastroesophageal Reflux Disease Discussion

 

 

References

Chapelle, N., Ben Ghezala, I., Barkun, A., & Bardou, M. (2021). The pharmacotherapeutic management of gastroesophageal reflux disease (GERD). Expert Opinion on Pharmacotherapy, 22(2), 219-227. https://doi.org/10.1080/14656566.2020.1817385

DeWitt, J. M., Siwiec, R. M., Perkins, A., Baik, D., Kessler, W. R., Nowak, T. V., … & Al-Haddad, M. A. (2021). Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response. Endoscopy International Open, 9(11), E1692-E1701. DOI: 10.1055/a-1546-8415

Ford, T. J., & Berry, C. (2020). Angina: contemporary diagnosis and management. Heart, 106(5), 387-398. https://doi.org/10.1136/heartjnl-2018-314661

Katzka, D. A., & Kahrilas, P. J. (2020). Advances in the diagnosis and management of gastroesophageal reflux disease. Bmj, 371. https://doi.org/10.1136/bmj.m3786

Maret-Ouda, J., Markar, S. R., & Lagergren, J. (2020). Gastroesophageal reflux disease: a review. Jama, 324(24), 2536-2547. doi:10.1001/jama.2020.21360

Patel, D. A., Yadlapati, R., & Vaezi, M. F. (2022). Esophageal motility disorders: current approach to diagnostics and therapeutics. Gastroenterology, 162(6), 1617-1634. https://doi.org/10.1053/j.gastro.2021.12.289

Roman, S., Pandolfino, J. E., & Kahrilas, P. J. (2022). Gastroesophageal reflux disease. Yamada’s Textbook of Gastroenterology, 815-838. https://doi.org/10.1002/9781119600206.ch43 Primary Diagnosis Of Gastroesophageal Reflux Disease Discussion

In this exercise, you will complete a Mind Map Template to gauge your understanding of this week’s content. Select one of the possible topics provided to complete your MindMap Template.

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• Gastroesophageal Reflux Disease

If needed:
Note: These readings are intended to serve as supplementary to the Lecturio content provided in this course. Please refer/review these supplementary resources should you need help in reinforcing concepts and in preparation for completing this week’s Assessments.
• McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
o Chapter 38: Structure and Function of the Renal and Urological Systems including Summary Review
o Chapter 39: Alteration of Renal and Urinary Function (stop at Fluids and electrolytes); Summary Review
o Chapter 41: Structure and Function of the Digestive System (stop at Tests of digestive function); Summary Review
o Chapter 42: Alterations of Digestive Function (stop at Cancer of the digestive track); Summary Review Primary Diagnosis Of Gastroesophageal Reflux Disease Discussion