Initial Post: Summarize the pathophysiology of Peptic Ulcer Disease as compared to GERD and explain which one of his symptoms most closely represent. Support with evidence.
Peptic ulcer disease is a break or an ulceration in the mucosal lining of the lower esophagus, stomach, or duodenum which is supposed to protect these organs (McCance, 2018). Peptic ulcers may be an acute finding or can occur chronically. There are risk factors that can increase the occurrence of peptic ulcer disease including, genetics, smoking, COPD, obesity, acute pancreatitis and excessive use of alcohol and/or NSAIDs. According to Yim, Kim & Lee, peptic ulcer disease may also be caused by helicobacter pylori (H. Pylori) infection (2021). The most chronic type of peptic ulcers are known as duodenal ulcers. When duodenal ulcers are present there is chronic intermittent pain in the patient’s epigastric area. The pain begins 30 minutes to 2 hours after eating when the stomach is empty and is relieved with food and antacids.
GERD an acronym for gastroesophageal reflux disease. GERD occurs when there is an increase in acid and pepsin refluxes from the stomach in the esophagus that causes irritation to the esophagus. This irritation is known as esophagitis. The lower esophageal sphincter is typically lower than normal due to transient relaxation and/or weakness of the sphincter (McCance, 2018). Increased abdominal pressure such as vomiting, coughing, lifting, bending, obesity or pregnancy can also contribute to the diagnosis of GERD as well. The symptoms of GERD are as follows: Heartburn due to acid regurgitation, chronic cough, asthma, sinusitis, and/or upper abdominal pain within the first hour of eating.
The symptoms that the patient has presented with are closer to the symptoms that are present in peptic ulcer disease due to the presentation of daily aspirin usage, pain and burning sensation in the mid sternum and epigastric region, and daily alcohol consumption. His occasional coughing could be related to GERD, but his symptoms seem to be more within the category of peptic ulcer disease.
Reference
McCance, K.,L., & Huether, S., E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed) St Louis, MO: Mosby Inc; ISBN-13: 978-0323583473.
Yim, M. H., Kim, K. H., & Lee, B. J. (2021). The number of household members as a risk factor for peptic ulcer disease. Scientific Reports, 11(1), 1–10. https://doi-org.su.idm.oclc.org/10.1038/s41598-021-84892-5.
Peer 2
Inflammation of the mucosal lining of the lower esophagus, stomach, or duodenum, which is designed to protect these organs, results in a break or an ulceration (McCance, 2018). Peptic ulcers can manifest itself as an acute occurrence or as a chronic condition. Genetics, smoking, chronic obstructive pulmonary disease (COPD), obesity, acute pancreatitis, and excessive use of alcoholic beverages and nonsteroidal anti-inflammatory drugs (NSAIDs) are all risk factors for the development of peptic ulcer disease. According to Yim, Kim, and Lee, helicobacter pylori (H. Pylori) infection may also be a contributing factor to peptic ulcer disease (2021). Duodenal ulcers are the most severe form of peptic ulcers and are the most difficult to treat. When duodenal ulcers are present, the patient will have persistent intermittent discomfort in the epigastric portion of the stomach. The pain comes 30 minutes to 2 hours after eating when the stomach is empty and is addressed by eating and taking antacids to relieve the discomfort.
Gastroesophageal reflux disease (GERD) is an acronym for gastroesophageal reflux disease. GERD occurs when the amount of acid and pepsin produced by the stomach increases and refluxes into the esophagus, causing irritation to the esophagus and stomach. Esophagitis is the medical term for this type of inflammation. Lower esophageal sphincter relaxation and/or weakness are common causes of abnormally low lower esophageal sphincter relaxation and/or weakness (McCance, 2018). High abdominal pressure caused by vomiting, coughing, lifting and bending, being overweight or pregnant can all contribute to the diagnosis of gastroesophageal reflux disease (GERD). Acute gastroesophageal reflux disease (GERD) is characterized by the following symptoms: heartburn due to acid regurgitation, chronic cough, asthma, sinusitis, and/or upper abdomen pain within an hour of eating.
Because of the patient’s history of daily aspirin use, pain and burning sensation in the mid sternum and epigastric region, and daily alcohol intake, the symptoms that the patient has presented with are more similar to those that are present in peptic ulcer disease. His coughing spells could be due to gastroesophageal reflux disease (GERD), but his symptoms appear to be more consistent with peptic ulcer illness.
Reference
McCance, K.L., & Huether, S.E. (in press) (2018). Pathophysiology is the study of the biological foundation of disease in both adults and children (8th ed) Mosby Inc., St. Louis, Missouri; ISBN-13: 978-0323583473.
M. H. Yim, K. H. Kim, and B. J. Lee have published a paper in which they argue that (2021). The number of people living in the same household as a risk factor for peptic ulcer disease Scientific Reports, vol. 11, no. 1, pp. 1–10. https://doi-org.su.idm.oclc.org/10.1038/s41598-021-84892-5.
Peer No. 2
Reflux Disease of the Gastroesophageal Reflux
Stomach reflux disease is a medical illness characterized by abnormalities in lower esophageal function, including esophageal motility and gastric emptying; it is also known as acid reflux disease or acid indigestion. When the lower esophageal sphincter’s resting tone is lower than usual, this condition is known as reflux. There are numerous variables that lead to its development, including vomiting, coughing, lifting, bending, and being overweight. Because of the increased abdominal pressure that they create, these have an effect on the tone of the esophageal sphincter.
Gastroesophageal Reflux Disease
Gastroesophageal Reflux Disease is a condition cause by abnormalities of lower esophageal function, esophageal motility, gastric motility, and gastric emptying. This occurs when the resting tone of the lower esophageal sphincter is lower than normal. There are a multitude of factors that contribute to this development including vomiting, coughing, lifting, bending and obesity. These influence the tone of the esophageal sphincter due to the increased abdominal pressure they cause.
Disorders such as gastroparesis, gastric ulcers are associated with delayed gastric emptying which lengthens the time span in which reflux is possible and increases the acid content of Chyme. Exaggerating the symptoms of reflux.
The severity of this condition depends on the composition of gastric contents and esophageal mucosa exposure time. When gastric contents are highly acidic or contain bile salts and pancreatic enzymes reflux can be severe. In the individual with weak esophageal peristalsis, reflux chyme remains in the esophagus for a longer period of time causing damage to the mucosa which can eventually become cancerous.
Symptoms of GERD include heartburn, chronic cough, asthma attacks, laryngitis, sinusitis, weight loss and upper abdominal pain within an hour of eating. Symptoms may be exacerbated when laying down or after consuming alcohol or acidic foods.
Peptic Ulcer Disease
Peptic Ulcer Disease occurs when there is a break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum. Peptic ulcers can be singe or multiple, acute or chronic, and superficial or deep. Superficial ulcerations are called erosions because they erode the mucosa by but do not penetrate the muscularis mucosa. True ulcers extend throughout the muscularis mucosa, damaging blood vessels, causing hemorrhage or perforating the gastrointestinal wall.
The chronic use of NSAIDs suppress mucosal prostaglandin synthesis, decreasing bicarbonate secretion and mucin production while increasing the secretion of hydrochloric acid. H. Pylori, a bacterium, typically found in the stomach, interacts with NSAIDs causing disruption of the mucosa, exposing submucosal areas to gastric secretions and auto digestion, leading to erosion and ulcerations.
Symptoms include chronic intermittent epigastric pain, often occurring 30 minutes to 2 hours after eating and in the middle of the night. This pain may be relieved by food or antacids and exacerbated by acidic foods and muscle spasms. Loss of appetite and weight loss are often present in this condition. These symptoms most closely align with they symptoms experienced by the patient in the discussion scenario (McCance & Huether, 2019)
References:
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2019). Pathophysiology: the biologic basis for disease in adults and children (8th ed.). Elsevier
