Importance of Pharmacologic and Lifestyle Changes in the Treatment of Gastroesophageal Reflux

The Importance of Pharmacologic and Lifestyle Changes in the Treatment of Gastroesophageal Reflux
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September 3, 2021
Understanding the relationship between illnesses and the effectiveness of drugs is essential for any healthcare practitioner. It allows him to appreciate a drug's mechanism of action better and use this knowledge to create a treatment plan that should ultimately benefit the patient. In this article, the author would like to focus on one of the most common illnesses that people experience around the world – Gastroesophageal Reflux Disease (GERD). GERD is primarily characterized by a reflux of an individual's stomach to the esophagus, which can cause irritation or even permanent damage in prolonged cases. In line with this, the succeeding sections of this paper will discuss the pathophysiology of the disease, including its epidemiology, clinical features, and usual treatment processes, among others. Overall, the author believes that an in-depth understanding of the disease can help provide a more appropriate and cost-effective treatment that can be used in one's future practice.
Epidemiology of the Disease
GERD is a common disease that individuals around the world experience. In the United States alone, studies show that about 18.1% to 27.8% of American Adults have been experiencing the disease CITATION Ant21 \l 1033 (Antunes, Abdul, & Curtis, 2021). In the world, current estimates show that the disease afflicts an estimate of 8,819 cases per 100,000 individuals in 2017 CITATION Swe20 \l 1033 (Sweis & Fox, 2020). Between sexes, studies also show that men are more likely to be afflicted with this disease as compared to women. Nonetheless, both genders could also have a higher prevalence than the above estimates because of the broad access to over-the-counter antacids, which could dramatically reduce reported disease cases CITATION Ant21 \l 1033 (Antunes, Abdul, & Curtis, 2021).
Symptoms and Clinical Features
Some of the most common symptoms of GERD are heartburn and regurgitation. Even though the disease rarely exhibits any physical symptoms, these two cardinal symptoms are the usual illness presentation, whether short or chronic. Additionally, the disease could also manifest other symptoms such as chronic cough, chest pain, sore throat, globus sensation, and bloating, among others CITATION Dig20 \l 1033 (Dighe, 2020).
Although diagnosing the disease is relatively easy because of the presence of its two cardinal symptoms, there are also times when the presence of other diseases could make the assessment more difficult. Nonetheless, one of the most critical aspects of the diagnostic process is history taking. It allows the healthcare practitioner to isolate the symptoms and determine the triggers in the patient's case. In most cases, however, a presumptive diagnosis of the disease could usually be estimated when there is the presence of both regurgitation and heartburn CITATION Dig20 \l 1033 (Dighe, 2020).
Aside from history taking, Proton Pump Inhibitors (PPIs) can also be used as a confirmatory test for the disease. This technique, also known as the Empiric PPI Trial, is done by prescribing a two-week therapeutic trial of a double dose PPI to the patient to determine whether the symptoms are alleviated. Current studies done on various instances show that the use of the Empiric PPI Trial is mostly accurate since the sensitivity and specificity results are 78% and 54%, respectively (Durazzo et al., 2020).
As stated earlier, the diagnosis of GERD can usually be made either through simple history taking or the use of PPI Trial in other cases. However, other diagnostic treatments could also be asked in the presence of other co-morbidities or symptoms, such as endoscopy, biopsy, barium swallow, esophageal manometry, ambulatory pH monitoring, and FSSG questionnaire.
Pathophysiology of the Disease
The leading cause of GERD is the failure of the body's standard antireflux barriers to protect against frequent and abnormal amounts of reflux materials CITATION Tac18 \l 1033 (Tack & Pandolfino, 2018). Typically, gastric acid levels should only have a pH of 1.5 to 3.5. This acidity is brought about and maintained by the parietal cells lining the stomach through the constant secretion of gastrin, acetylcholine, and histamine, among other enzymes used for the digestive process CITATION Har13 \l 1033 (Hart, 2013). Thus, reflux happens from the stomach to the esophagus when there is an imbalance in the hormones causing the sphincter's closure or those related to the secretion of acidic digestive enzymes.
Usually, the defensive factors that the body has against the disease include antireflux barriers, tissue resistance, and esophageal acid clearance.
First, the antireflux barriers refer to the mechanisms of the body that usually prevent reflux when they are working normally. This barrier includes various anatomical structures such as the phrenoesophageal ligament, the crural diaphragm, and the lower esophageal sphincters. When these anatomical features are lax (or fails to close), reflux happens as a result. Thus, some of the confirmatory and exploratory tests used to determine the cause of GERD could look into the strength of the "intraluminal pressure at the esophagogastric region (EGJ)" to determine whether there is indeed a weakening of this barrier CITATION Mit21 \l 1033 (Mittal, 2021).
Second, tissue resistance is another defensive factor in GERD's pathophysiology since the strength of the esophageal lining could affect the occurrence of the symptoms. For example, some studies show that various circumstances (or illnesses) could lead to endothelial dysfunctions that could reduce tissue resistance in the esophageal region, which ultimately increase both the occurrence and the effect of GERD CITATION Opa17 \l 1033 (Oparin & Vnukova, 2017).
Finally, the esophageal acid clearance could also act as a defensive factor for the disease. Since the prolonged duration of acid clearance can cause more injury to the esophagus, the presence and effectiveness of acid-clearing mechanisms are essential. Common examples of these acid-clearing mechanisms include peristalsis and titration by saliva with its bicarbonate content.
Finally, GERD's pathophysiology also suggests several factors that could exacerbate the presence of these symptoms. Some of these include pregnancy, abdominal obesity, disruption...