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The given study focuses on Ms Sarah, a 41 year-old female who has been admitted for the procedure of undergoing a Gastroscopy. Her presenting symptoms include nausea, food regurgitation and discomfort in the upper abdomen. Her examination revealed high alcohol intake along with high intake of sugar and fats and low intake of fruits and vegetables. Her BMI upon examination is 35 along with blood pressure of 162/88. It is a condition characterized by the presence of reflux of the contents of the stomach into the oesophagus which leads to symptoms like heart-burn and regurgitation. Sarah is suspected to have the same. This cases study will discuss the pathophysiology of Gastroesophageal reflux disease(GERD).
GERD mainly manifests itself as a combination of complexes and is characterized by reflux exposure, resistance of the epithelial cells and sensitivity of the viscera. It is caused by a number of factors such as relaxation of the lower oesophagial sphincter and abnormalities in the lower oesophageal sphincter pressure. However, there exist a combination of other factors as well such as impaired clearance of the oesophagus, impairment of the mucosal defensive factors and delayed gastric emptying (Patti et al 2020).
Existing conditions such as Hiatal hernia can also contribute to the development of GERD. Impaired clearance of the oesophagus leads to prolonged exposure of the stomach mucosa to acid, whereas delaying of the gastric emptying causes gastric distension, which causes a relaxation of the lower oesophageal sphincter(LES). A combination of the above can cause gastroesophageal reflux disorder. The mechanisms underlying the pathophysiology is attributed to either the gastric acid coming directly in contact with the upper airway or the initiation of the vago-vagal reflex due to the presence of acid in the distal oesophagus (Oppia et al 2017). Risk factors such as obesity, intake of alcohol, nicotine, diet pattern are also responsible for LES incompetence.
Clinical manifestations could both be subjective and objective, subjective when perceived by the patient and objective when the doctor/physician observes them. Most common clinical manifestations of GERD include the following – Heartburn characterized by a feeling of continuous burning in the chest along with discomfort in the upper abdomen. It occurs mostly in the night , after eating. Other symptoms include a difficulty in swallowing food, accompanied chest pain and regurgitation of food or acid in the mouth (Nguyen et al 2019).
Apart from the above mentioned clinical manifestations, Sarah also demonstrates a tooth decay. Tooth decay associated with GERD is extremely common because of the acid reflux caused by GERD. The acid seeped through from the oesophagus into the oral cavity causes an erosion of the enamel of the teeth. Usually affected teeth are the molars especially the enamel present on their back side. Sometimes, an oral exam usually presenting with this kind of a tooth decay is able to diagnose GERD in the patient. A dental physician is usually the first person to identify this tooth decay and help with it (Moini et al 2018).
The dental expert can help in initial identification of GERD and associated tooth decay and can also help in recommending nutritional and lifestyle changes along with a medical referral to a gastroenterologist who will specifically treat the manifestations of GERD in the esophagus and stomach. The tooth decay pattern and cause will be explained to the patient by the dentist along with dietary modifications while the, gastroenterologist will provide symptomatic treatment to help prevent the acid reflux. She should also be referred to a dietician to help her change her diet pattern and help her reduce her weight and improve her BMI from 35 since, her existing diet pattern and her BMI are both a risk for GERD and need to be improved.
The most commonly prescribed drug for GERD is Omeprazole- a proton pump inhibitor. It acts by binding to the proton pump- H positive/K positive present in the gastric parietal cells and exchanges the ATPase present there. This leads to suppression of the basal acid secretion along with stimulated acid secretion suppression. Its main work is to suppress acid secretion in the stomach and is therefore, used in the treatment of duodenal and peptic ulcers, GERD, esophagitis etc. It is contraindicated in patients of liver and kidney diseases along with SLE, inadequate Vit. B12 absorption and Clostridium associated diarrohea as well (Tkach et al 2016).
Ms Sarah’s case study was discussed here which helped in establishing the criteria for diagnosis of gastro-esophageal reflux disorder (GERD). She was admitted for a gastroscopy and presented with nausea, abdominal discomfort and food regurgitation- all signs of GERD. The pathophysiology and clinical manifestations of GERD were discussed along with its treatment with a proton pump inhibitor- Omeprazole was explained along with its action and contraindications. This case helped understand the effective and proper management of GERD.
Moini, F., Kamalinejad, M., & Babaeian, M. (2018). Dental erosion stemmed from gastroesophageal reflux in Avicenna's view. Advanced Herbal Medicine, 4(1), 1-2.
Nguyen, B. V., Topilin, O. G., & Ovsyannikov, D. Y. (2019). Acid, non-acid reflux and clinical manifestations of GERD. A meta-analysis. SCIENCE4HEALTH, 134-134.
Oppia, F., & Cabras, F. (2017). Overview of pathophysiological features of GERD. Minerva Gastroenterologica e Dietologica, 63(3), 184-197.
Patti, M. G., Schlottmann, F., & Farrell, T. M. (2020). Pathophysiology of gastroesophageal reflux disease in obese patients. The Perfect Sleeve Gastrectomy 169-176.
Tkach, V., Ivanushko, Y., de Oliveira, S. C., da Silva, G. R., Ojani, R., & Yagodynets, P. I. (2016). The theoretical evaluation of the possibility of CoO (OH)-assisted omeprazole electrochemical detection. Anal. Bioanal. Electrochem, 8, 749.
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