Question

CASE STUDY 3.1 A friend has disclosed that she has been having prob- lems with heartburn. She has been told that she has gastroesophageal reflux disease (GERD), in which stomach acid backs up into the esophagus, causing esophagitis. Think about which clinical model is most related to this process. From your reading re- lated to cellular injury and adaptations as well as inflammation, answer the following questions: 1. What anatomic problem most likely leads to gas- troesophageal reflux? 2. What is the injury in gastroesophageal reflux? 3. What would the acute inflammatory response 4. Why might this condition become a chronic 5. What pathophysiologic changes would most likely look like? problem? occur with chronic gastroesophageal reflux?

6. What would you expect for clinical manisfestations?

7. What diagnostic tests might be used?

8. What treatment measures would you anticipate?

Answer 1

1. Anatomic Problem Leads To GERD;

The most important problem that leads to GERD is the poor closure of Lower esophageal sphincter which is the junction between stomach and esophagus. In detail , for a normal person the valve between stomach and esophagus opens when the food enter and close after passing food contents . But for a person who is having dysfunctional Valve does not close after food entry , so there will be a mixing up of acidic fluids and refluxing back into the esophagus. This is what happening for a GERD patient . Esophageal valve become dysfunctional due to any chest injuries , obesity, age and also some people naturally has less valve function .

2 Injury in GERD ;

Gastroesophageal reflux disease occurs when the gastric juice refux back from stomach to esophagus, when it becomes in higher amounts causes mucosal injury that means Inflammation of the esophagus (esophagitis)

3 Acute inflammatory response look like;

Difficulty in swallowing

Pain while swallowing food

Feels like food get stucked in throat

Tearing of esophagus lining tissue

Narrowing of esophagus

Difficulty in breathing

4 GERD become a chronic problem ;

When GERD is not treated , it may cause serious complications like easophagitis , cancer of esophagus . Easophagitis will cause bleeding , ulcers , narrowing and scarring of esophagus .GERD is a chronic disease but it’s a treatable disease.

5 Pathophysiology of GERD ;

Due to any chest injury ,genetic , obesity, or age factor

leads to

Esophageal valve dysfunction

leads to

Lacks closing gastroesophageal valve after passage of food

leads to

Abnormal amount of acids reflux back from stomach to esophagus

leads to

Symptoms such as acid taste in mouth ,chest pain , vomiting , breathing problems

leads to

Complications like Esophagitis , cancer of esophagus , narrowing of esophagus

6 clinical manifestation of GERD ;

Heart burn

Sore throat

Chest pain

Difficulty in swallowing

Vomiting

Shortness of breath

7 Diagnostic tests;

Barium swallow test : This test helps to identity ulcer and narrowing of esophagus .

PH monitoring   : This helps to check the acid in the esophagus

Esophageal manometry: This test is to check the function of Esophagus

Endoscopy.   :This test is done to identify any problems in stomach . This test is also used to take biopsy to test for any complications of GERD

8 Treatment Measures

Treatment measures include;

1. Dietary modifications

2.Reducing weight

3.Avoid sleeping immediately after meals

4.chew and eat slowly

5.Avoid wearing tight clothings

6. Stop smoking

7 practice relaxation techniques

8 use medications to reduce acid production e.g;H2 receptor blockers

9.use medications to block acid production e.g;proton pump inhibitors

10.Antacids to heal inflamed esophagus and neutralise stomach acid

11. Fundoplication is the surgery option where the surgeron will cover the top of stomach around the lower esophageal sphincter to tighten muscle and to prevent acid reflux .