Pathogenesis of Gastroesophageal Reflux Disease (GERD)
Introduction
Gastroesophageal reflux disease (GERD) is a medical condition that results from the mucosal damage caused by stomach acid or any other irritants. The damage occurs due to the abnormal reflux of acid or other irritants from the stomach to the esophagus. The disease is also referred to by other names including acid reflux disease, gastro-oesophageal reflux disease (GORD) or gastric reflux disease. The choice of this condition was based on the fact that I desired to understand deeply about this disease. I was diagnosed with this condition a year ago.
Etiology of Gastroesophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD) is commonly caused by cardia failure. This occurs as a result of permanent or transient changes in the valve which has “the angle of his” and acts as a barrier that prevents reflux of stomach content in to the oesophagus. The acute “angle of his” is created between the cardia and is positioned at the entry point of contents from the oesophagus into the stomach. The angle forms a regulatory valve that prevents reflux of stomach acid, enzymes and duodenal bile from flowing back into the oesophagus. The backflow of these stomach contents due to failure of this mechanism causes inflammation and mucosal damage. Subsequently, these resultant effects cause the gastroesophageal reflux disease (GERD) (Diamant, 2006). There are several factors known to contribute to the development of GERD. These include hiatal hernia-a condition that is caused by the protrusion of the upper part of the stomach into the oesophagus. This may be caused by weakness or tear of the diaphragm. Thus, the condition increases chances of the GERD condition by motility and mechanical factors that influence the movement of stomach content. The increase in body mass due to obesity is mostly implicated in serous conditions of GERD. Research has shown that at least 13% of 2000 individuals with this condition have developed the disease as a result of changes in body mass index. Other conditions including hypercalcemia and Zollinger-Ellison aggravate GERD because they cause excessive production of gastrin. This excess gastrin causes increased levels of gastric acidity. Visceroptosis condition is also implicated in causing GERD because it causes the sinking of the stomach into the abdomen and thus, affecting the secretion of acid and motility of the stomach. The use of some medicines including prednisolone and other conditions such as systemic sclerosis and scleroderma that cause dysmotility of the oesophagus can also cause GERD (Diamant, 2006).
Signs and symptoms of Gastroesophageal reflux disease (GERD)
A frequent heartburn, trouble in swallowing (dysphagia) and regurgitation are the most common typical symptoms for GERD. However, there are other indicative symptoms that are less common amongst patients having GERD. These include swallowing pain (odynophagia), pain in the chest, nausea and excessive salivation. The later is a response of the body towards the excessive acid irritation (saliva is basic and thus, the body produces more of it in a bid to neutralize the stomach acid) (Diamant, 2006).The condition can be exacerbated by elements that add to the irritants content or influence the stomach conditions. These possible exacerbating elements may include alcohol, aspirin, stomach tingling/constriction/discomfort, lipitor and toprol. Toprol is known to cause discomfort in the stomach in about 1-10 percent cases. Whereas, lipitor causes dyspepsia in 1-3 percent cases of which GERD could be a cause.Pathophysiology of GERD shows that it may result into the occurrence of other numerous medical conditions connected to its symptoms. These result from the injuries that GERD causes on the esophageal mucosa lining. Reflux oesophagitis or the ulceration of the epithelial tissues of the oesophagus at the stomach junction is one such manifestation of the damages that result from GERD. GERD also causes the esophagus to narrow due to the inflammation caused (esophageal strictures). The condition is also implicated in the symptomatic change of epithelial cells (squamous) to columnar epithelial cells, a condition known as Barrett’s esophagus. Cancer of the throat could also result from GERD (esophageal adenocarcinoma) (Porth, Pooler & Hannon, 2009).According to Diamant (2006) there are also others symptomatic changes held in association with GERD if it is proven to have preceded these changes by causing injuries in the esophagus. These conditions include laryngitis, dental enamel erosion, dental hypersensitivity, asthma, sinusitis and chronic coughs.
Typical diagnostic indicators of Gastroesophageal reflux disease (GERD)
Diagnosis of GERD is carried out by the use of various methods including esophageal manometry, esophageal pH monitoring, x-rays (after barium swallows) and esophagogastrodoudenoscopy (EGD). Positive response to proton inhibitors after a short-while prescription in terms of acidity reduction is a positive diagnostic indicator of the existence of GERD (Diamant, 2006). EGD is also carried out when a patient does not respond as expected to the proton inhibitors but, exhibits alarming symptoms including blood in the stool, dysphagia, loss of weight and anemia.The presence of Barrett’s oesophagus is an indicative symptom for GERD’s existence and its lesions could be precursors for esophageal adenocarcinoma. Other typical diagnostic indicators that are detected after biopsies include basal hyperplasia, edema, papillae elongation, squamous cell layer thinning, dysplasia, and neutrophillic, lymphocytic and eosinophilic inflammations (Porth, Pooler & Hannon, 2009).
Treatments and interventions for GERD
Several drugs are used in treating the condition. These include proton pump inhibitors which reduce stomach acid levels. H2 receptor blockers (gastric) are also used to reduce stomach acidity by reducing acid secretion. The use of anti-acids before meals also serves to reduce resultant high acid levels that occur after meals. Other types of drugs help to heal damaged tissues in the oesophagus, an example is sucralfate. The use of prokinetics to strengthen the lower esophageal sphincter helps treat GERD that results from hiatus hernia. Alginic acid is also used to increase the mucosa coating and reduce inflammation of the esophagus (Orlando, 2000). In extreme cases of damage surgical corrections are recommended. The change of lifestyle in terms of diet and positioning at sleep can be used as additional therapies. This control would include reduction of alcohol intake, smoking and acidic foods.The disease has a multi-factorial pathogenesis and recent research is centered on the inter-relation of these factors in the cause and influence on progression of the disease. Further research is necessary for the establishment of the relationship of the lower esophageal sphincter and GERD to the smooth, circular distal esophageal body muscles.
References
Diamant. E. N. (2006). Oral Cavity, Pharynx and esophagus: Pathophysiology of gastoesophageal reflux disease. Retrieved from GI motility online at, http://www.nature.com/gimo/contents/pt1/full/gimo21.html, on 19th May 2010.
Orlando, C. R. (2000).Gastroesophageal reflux disease. Tampa, FL: Informa Health Care.
Porth, C.M, Pooler, C, Hannon, A.R. (2009). Porth Pathophysiology: Concepts of altered health states, eighth edition. Hagerstown, Maryland, U.S: Lippincott Williams and Wilkins Publishers.
Is this your assignment or some part of it?
We can do it for you! Click to Order!
