These three phases release acetylcholine, gastrin, and histamine which stimulates hydrochloric acid (HCl) secretion from the parietal cells with the help of acid-secreting pumps such as H+/K+-ATPase (Mills & Stappenbeck, 2017). Changes with GERDGastroesophageal reflux disease (GERD) occurs when the acid from the stomach backs up into the esophagus causing inflammation and burning to the lining causing heartburn and regurgitation (Huether, 2017). GERD occurs due to a transient loss of pressure in the lower esophageal sphincter (LES) from diet, obesity, smoking, alcohol, medications, and hiatus hernia (Pandit, Boktor, Alexander, Becker, & Morris, 2017). Other causes are due to esophageal motility and delayed gastric emptying (Huether, 2017). When delayed gastric emptying transpires, there is a longer period of reflux occurring and an increase in gastric acid content (Huether, 2017). History and physical are used to diagnose GERD, and esophageal endoscopy and tissue biopsy are ordered to determine hyperemia, edema, erosion, strictures, and dysplastic changes (Huether, 2017). Proton pump inhibitors (PPI) are prescribed to resolve and control symptoms (Pandit et al., 2017). Other medications are used such as H2-receptor antagonist, prokinetics, and antacids (Huether, 2017). Weight loss, avoiding foods that cause reflux, cessation of smoking and alcohol consumption are techniques to manage GERD symptoms (Pandit et al., 2017). Surgical treatment for GERD includes Nissen fundoplication, Belsey Mark IV, Hill Gastropexy, gastric bypass, and endoscopic therapies (Pandit et al., 2017).
4Changes with PUDPeptic ulcer disease typically occurs in the stomach or duodenum and transpires with a break in the mucosal lining, infiltrating the submucosa usually due to Helicobacter pyloriand theuse of non-steroidal anti-inflammatory drug (NSAIDs) (Lana & Chan, 2017). H. pyloricause an inflammatory response and cytokines are released that damage the gastric epithelium (Huether, 2017). Mucosal damage occurs with NSAID use due to a disruption of mucus phospholipids, thecell membrane, and the uncoupling of mitochondrial oxidative phosphorylation causing prostaglandin inhibition and vascular damage (Lana & Chan, 2017). Endoscopy is used to diagnosis PUD, along with urea breath and stool antigen tests to detect H. pylori(Lana & Chan, 2017). Treatment involves preventing recurrence of ulcers by eradicating H. pyloriinfection with the use of PPI and two antibiotic therapies such as clarithromycin and amoxicillin but can be difficult with the prevalence of antibiotic resistance (Lana & Chan, 2017).
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- Fall '17
- keisha lovence
- Helicobacter pylori, gastritis