Acute Gastroesophageal Reflux Disease (GERD)

at
Categories
Tags

 

Patient Information:

• Name: Laura Martinez

• Age: 35 years • Gender: Female

• Occupation: Teacher

• Medical History: Laura has a history of occasional heartburn and GERD symptoms, managed with antacids as needed. She has no known allergies.

Presenting Complaint: Laura presents to the clinic with complaints of severe chest pain and burning sensation behind the sternum for the past two days. She describes the pain as a sharp, burning sensation that worsens after meals and when lying down. She reports regurgitation of sour-tasting fluid into her mouth and occasional difficulty swallowing. She denies any associated symptoms such as fever, cough, or abdominal pain.

Physical Examination:

• Vital Signs: BP 120/80 mmHg, HR 70 bpm, RR 16/min, Temp 98.4°F (36.9°C)

• Chest Examination: No abnormal findings on auscultation, no signs of respiratory distress

• Abdominal Examination: Soft and non-tender, no organomegaly

• Other Findings: No signs of anemia or jaundice

Investigations:

1. Upper Endoscopy: Shows evidence of esophageal mucosal injury (erosive esophagitis) with mucosal breaks and inflammation, indicative of GERD.

2. Esophageal pH Monitoring: Confirms increased acid exposure in the distal esophagus, consistent with GERD.

Diagnosis: Acute Gastroesophageal Reflux Disease (GERD) with erosive esophagitis

Management: Laura is advised on lifestyle modifications, including avoiding trigger foods (e.g., spicy, fatty foods), eating smaller meals, and avoiding lying down after meals. She is prescribed a proton pump inhibitor (PPI) for 4-8 weeks to suppress gastric acid secretion and promote healing of esophageal mucosa. Antacids are provided for immediate relief of symptoms as needed.

Questions:

1. What are the typical symptoms of GERD, and how is it differentiated from other causes of chest pain?

2. Describe the endoscopic findings seen in erosive esophagitis.

3. Discuss the pathophysiology of GERD and factors contributing to its development.

4. Outline the pharmacological and non-pharmacological management strategies for GERD, including the role of PPIs, antacids, and lifestyle modifications.

Sample Solution

Gastroesophageal Reflux Disease (GERD) in Laura’s Case

  1. GERD Symptoms and Differentiation from Other Causes of Chest Pain:

GERD Symptoms:

  • Heartburn: A burning sensation behind the breastbone, often worse after eating or lying down.
  • Regurgitation: Sour-tasting fluid or food backing up into the mouth or throat.
  • Acid reflux: Similar to heartburn, but the acidic fluid may reach the back of the throat or mouth, causing a sour taste.
  • Chest pain: Can mimic angina (chest pain due to heart issues) but typically feels like a burning sensation rather than a squeezing pressure.
  • Dysphagia: Difficulty swallowing.
  • Nausea: Feeling of sickness or queasiness.

Differentiating GERD from Other Causes of Chest Pain:

  • Angina: Often described as a squeezing pressure radiating to the arm, jaw, or back. May be triggered by exertion and relieved by rest or medication.
  • Musculoskeletal pain: Pain can be sharp and localized to a specific area of the chest wall. May be associated with specific movements or tenderness on touch.
  • Pleurisy (inflammation of the lung lining): Sharp, stabbing pain that worsens with deep breathing or coughing.
  1. Endoscopic Findings in Erosive Esophagitis:
  • Mucosal injury: Presence of breaks, cracks, or erosions in the lining of the esophagus.
  • Inflammation: Reddening, swelling, or irritation of the esophageal tissue.
  • Possible bleeding: In severe cases, there might be visible signs of minor bleeding.
  1. Pathophysiology and Contributing Factors of GERD:
  • Lower Esophageal Sphincter (LES) Dysfunction: The LES is a muscular valve between the esophagus and stomach. In GERD, the LES weakens or relaxes inappropriately, allowing stomach acid to reflux back into the esophagus.
  • Increased Stomach Acid Production: Certain foods, medications, or medical conditions can stimulate excessive acid production in the stomach.
  • Hiatal Hernia: A portion of the stomach pushes through the diaphragm (muscle separating the chest from the abdomen), weakening the LES and facilitating reflux.
  • Lifestyle factors: Overeating, eating fatty or spicy foods, smoking, alcohol consumption, and tight-fitting clothing can all contribute to GERD.
  1. Management of GERD:

Pharmacological:

  • Proton Pump Inhibitors (PPIs): The most effective medication for GERD. They suppress stomach acid production, allowing the esophagus to heal. Laura’s 4-8 week course is a typical treatment duration for acute GERD.
  • H2-Blockers: Less potent than PPIs but can be an option if PPIs are not tolerated or for milder cases.
  • Antacids: Provide rapid relief of heartburn symptoms but don’t address the underlying cause (acid production). They are best for occasional symptoms, not long-term management.

Non-pharmacological:

  • Lifestyle modifications: These are crucial for long-term management:
    • Diet: Avoid trigger foods (spicy, fatty, acidic), eat smaller and more frequent meals, maintain a healthy weight.
    • Elevation: Elevate the head of the bed by 6-8 inches to prevent acid reflux during sleep.
    • Loose-fitting clothing: Avoid tight clothing around the abdomen.
    • Smoking cessation: Smoking weakens the LES and worsens GERD.
    • Stress management: Stress can exacerbate symptoms. Relaxation techniques can be helpful.

In Laura’s case, the combination of PPI medication and lifestyle modifications aims to promote healing of the esophageal lining and prevent future episodes of GERD.

 

This question has been answered.

Get Answer