hir Baccus posted Dec 7, 2021 7:32 PMSubscribe
Initial Post: Summarize the pathophysiology of Peptic Ulcer Disease as compared to GERD and explain which one his symptoms most closely represent. Support with evidence.
Peptic ulcer disease (PUD) is a “break or ulceration, in the protective mucosal lining of the lower esophagus, stomach or duodenum” (McCance & Huether, 2018). The hydrochloric acid build up causes erosions, which damages the superficial layer of the mucosa. Overtime through continuous erosion, ulcers will extend through the muscularis mucosae and damage blood vessels, causing hemorrhage or perforating the gastrointestinal wall. According to McCance & Huether (2018), “risk factors for peptic ulcer disease include genetic predisposition, H. pylori infection of the gastric mucosa, and habitual use of aspirin and NSAIDs.”
In contrast, Gastroesophageal Reflux Disease (GERD) is identified by the backflow of acid and pepsin or bile salts from the stomach to the esophagus. The esophagus then becomes inflamed which is known as esophagitis. This movement of acid, pepsin, and bile salts from the stomach to the esophagus is facilitated by way of irregularities in the functioning of the lower esophageal sphincter (LES). The weakness or loosening of the LES allows reflux of stomach contents into the esophagus (McCance and Huether, 2018). According to Cheng et al. (2021), “risk factors in GERD include obesity, pregnancy, smoking, hiatal hernia and specific drugs, including antihistamines, calcium channel blockers, antidepressants, and sedatives that medicine help sleep.”
I believe this patient has symptoms of GERD but overall has more symptoms pertaining to PUD. It does state that the patient has an occasional dry cough at night and according to Cheng et al. (2021), “recent reviews on the epidemiology examines that GERD have different levels of causality about asthma, chronic dry cough, sleep apnea, non-cardiac chest pain, chest tightness, and chronic bronchitis.” The patient described in the case study takes aspirin daily and drinks beer daily, which are major risks factors and can lead to the development of peptic ulcers. In addition, he complains of epigastric burning weight loss, which are all symptoms of PUD. H. Pylori is a gram negative bacteria which is common in the development of PUD. H. Pylori causes increase in gastrin that promotes acid secretion and disturbs gastrointestinal motility. According to Salsabila et al. (2021), “patients with positive H. pylori complained of fullness, early satiety, epigastric pain or burning, nausea, persistent or occasional vomiting, loss of appetite, and frequent burping.”
Cheng, Y.-H., Tung, T.-H., Chen, P.-E., & Tsai, C.-Y. (2021). Risk of incident gastroesophageal reflux disease (GERD) in patients with sleep disorders: a population-based cohort study. Sleep & Biological Rhythms, 19(1), 5–11. https://doi-org.su.idm.oclc.org/10.1007/s41105-020-00282-w
McCance K., L., & Huether, S., E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.
Salsabila Budiman, G. T., Begawan Bestari, M., & Suryanti, S. (2021). Clinical and endoscopic features in helicobacter pylori infection: Literature review. Indonesian Journal of Gastroenterology, Hepatology & Digestive Endoscopy, 22(1), 66–72. https://doi-org.su.idm.oclc.org/10.24871/221202166-72
Peptic ulcer disease is a condition that affects the lining of the stomach. The condition occurs as a result of the imbalance between gastric mucosal protective agents and destructive factors such as increased levels of acidic content in the abdomen. When the condition, occurs, it is usually a sign of the defect of the mucosal lining, especially within the digestive system that extends to the muscularis mucosa. According to Lanas & Chan (2017), the most common cause of this condition is Helicobacter pylori (H. pylori), which is known to colonize abdominal walls thereby causing inflammation. The condition may also be exacerbated by the inability of mucosal cells to secret enough bicarbonates needed to neutralize the high acidic content. On the other hand, Gastroesophageal Reflux Disease (GERD) is a condition that is characterized by the backflow of gastric juices from the stomach into the esophagus (Clarrett & Hachem, 2018). It generally occurs as a result of changes in reflux exposure, epithelial resistance, and visceral sensitivity. This exposure causes injury of the esophagus thereby causing symptoms of the condition (Clarrett & Hachem, 2018). Known symptoms of the disease include sore throat, heartburn, belching, regurgitation and lower back pain in the upper abdomen (Clarrett & Hachem, 2018). Therefore, while the main underlying issue between the two conditions is acid, peptic ulcer disease is caused by inflammation of the mucosal lining by H. pylori, while GERD generally occurs due to changes in exposure to reflux within the esophagus (Clarrett & Hachem, 2018). Based on the patients daily behaviors and symptoms, I believe the Patient has Peptic Ulcer Disease.
Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal reflux disease (GERD). Missouri Medicine, 115(3), 214.
Lanas, A., & Chan, F. K. (2017). Peptic ulcer disease. The Lancet, 390(10094), 613-624.