Question

Charlie Berger, a 58-year-old obese man, comes to a nurse practitioner because he has difficulty swallowing, heartburn, and occasional regurgitation. Answering his nurse practitioner’s questions, Mr. Berger says that his symptoms worsen when he drinks coffee or alcohol. Endoscopy reveals inflammation in his lower esophagus and poor closure of the lower esophageal sphincter. There is no evidence of esophageal narrowing or movement of the proximal stomach into the thorax. The nurse practitioner diagnoses gastroesophageal reflux disease (GERD) and tells Mr. Berger to do the following: Take proton-pump inhibitor drugs to reduce gastric acid. Elevate the head of his bed. Avoid eating large meals, especially near bedtime. Enter a weight-loss program. Reduce his use of caffeine and alcohol. Answer the following questions about Mr. Berger and gastroesophageal reflux disease.

1. Why might reducing his use of caffeine and alcohol decrease Mr. Berger’s symptoms?

2. Why did his nurse practitioner tell Mr. Berger to elevate the head of his bed?

3. What is metaplasia? Why does it occur?

4. Why did his nurse practitioner suggest that Mr. Berger avoid eating large meals, especially near bedtime?

5. Why did his nurse practitioner check to see if Mr. Berger had movement of the proximal stomach into the thorax?

6. Are Mr. Berger’s symptoms of dysphagia, heartburn, and regurgitation specific to GERD?

7. In addition to discomfort, what is the danger of untreated GERD?

8. What is the mechanism by which obesity contributes to GERD?

Answer 1

1. Caffeine and alcohol have major role in aggregating the GERD symptoms. These may contribute to acid reflux because they may relaxes the oesophageal sphincter that exist between lower oesophageal and stomach. Normally this sphincter help to keep the food in stomach for digestive purposes. Relaxation of this muscle cause reflux. So by reducing the use of these beverages can help to relieve the symptoms associated with the patient.

2. Elevating head on bed is a lifestyle treatment for GERD patients. Acid leak out from stomach to oesophagus easily when patient is in sleeping position. As he elevate his head this make stop happening. The gravity makes less likely for stomach contents to go to oesophagus.

3. Metaplasia is the transformation of one differentiated cell to another form of differentiated cell. It occurs by the reversible substitution of one type of differentiated cell present in the tissue to another differentiated cell within the tissue. The neoplastic transformation occur at the site of metaplasia. It may cause change in epithelial tissue of organ gland or body cavity. The regulatory mechanism of metaplasia is unknown.

4. Eating large meals before going to bed can worsen the GERD symptoms. This may cause stomach acid to spill into oesophagus more likely if the patient goes to bed immediately after having the food. The gravity will not keep the digestive acids in stomach. Other tahn this this habit can cause weight gain and slows the metabolism when the person fall in sleep causing undigested calories stored as fat.