Question

Charlie Berger, a 58-year-old obese man, comes to his primary care provider because he has difficulty swallowing, has heartburn, and experiences occasional regurgitation. Answering his provider’s questions, Mr. Berger says that his symptoms worsen when he drinks coffee or alcohol.

Today, 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 provider diagnoses gastroesophageal reflux disease (GERD).

1. What lifestyle modifications should you teach Mr. Berger in order to prevent or reduce GERD symptoms?

2. Why did his provider check to see if Mr. Berger had movement of the proximal stomach into the thorax?

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

4. What is metaplasia? Why does it occur?

5. Why might reducing his intake of caffeine and alcohol decrease Mr. Berger's symptoms?

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

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

Answer 1

Answer : Gastroesophageal reflux disease is a chronic disease that occurs when stomach acid or bile flows into the food pipe and irritates the lining. The important lifestyle modifications for Preventing this condition are the following :- 1) Dietary changes : Avoid foods and drinks that trigger reflux such as fatty or fried foods, different sauces , chocolate and caffeine. 2) sleep atleast three hours after eating   to prevent reflux .Eat small amount of foods slowly and chew thoroughly 3)stop smoking and alcohol : Consumption of alcohol and nicotine can weaken lower esophageal sphincter that controls the opening between esophagus and stomach . 4) Raise the head of the bed so that your chest and head are higher than your feet to avoid heart burn ,then  don't use pillows because that can put more pressure on stomach and heart burn become more worse 5) Have plenty of water frequently . 6) reduce body weight : by reducing body weight ,we can control the disease . The lining of the esophagus can become inflamed or irritated from these acids, which can cause burning chest pain and sometimes a sour taste or cough. Checking movements of the proximal stomach into the thorax help to identify the problems related lungs . The increased risk of GERD is thought to be excess belly fat cause pressure on the stomach and increased prevalence of esophageal motor disorders ,higher number of transient relaxations of the lower esophageal sphincter .obesity cause hiatal hernia that is one of the factors for GERD . Metaplasia is a process whereby one type of mature tissue replaced another type of mature tissue not indigenous to that organs or tissues . Metaplastic transformation likely represents a reactive or reparative response to some chronic injury or irritations .Glandular metaplasia can occur as a result of injury in the distal esophagus with acid reflux from the stomach .Chronic injury may induce the convertion of the inflamed squamous mucosa to glandular mucosa that has many features of normal small intestinal mucosa.      1)Acid reflux occurs when the sphincter muscle at the lower end of your esophagus relaxes at the wrong time ,allowing stomach acid to back up into your esophagus .This can cause heart burn. 2) chronic reflux of stomach acids into your esophagus can irritate your throat. In severe cases ,it can cause dysphagia 3)regurgitation happens when a mixture of gastric juices and undigested foods rises back up the esophagus and into the mouth . If untreated ,GERD can cause 1) adult onset asthma 2) esophagitis 3) Barrett's esophagus 4) regurgitation of acid into the lungs 5) sinusitis 6) ulcerations or bleeding.