In this portion of our lecture, we will be talking about the common GI disorders, namely: gastroesophageal reflux disease (GERD), gastritis, and peptic ulcer.
There’s one thing in common when it comes to these three GI disorders: increased acid production. So, whether it’s GERD, gastritis or peptic ulcer, the cause is the same.
Anatomy and Physiology – Stomach
The normal physiology of your stomach regarding ingestion is first, food has to be swallowed down to the esophagus then passes through the esophageal-gastric sphincter muscle. The esophageal-gastric sphincter muscle is basically the muscle that “clamps up” to prevent stomach contents and acid from traveling back into the esophagus. Another sphincter is located at the base of your stomach. So, whenever a patient undergoes a lap-band surgery, the lap-band squeezes both sphincters to make patients feel like they’re full.
Acid Production Affectation
Whether it’s gastritis, GERD, or peptic ulcer, you have to remember that they all relate to one cause: too much acid production inside the stomach. Differentiation of each disorder entirely depends on where the acid production acts on and the effects on the areas of the digestive tract.
If acid production creeps up to the GI tract and “burns away” the esophagus, gastroesophageal reflux disease (GERD) or what is also known as heartburn, occurs. Some of the causes of heartburn or GERD are:
- Coffee due to caffeine
Therefore, to avoid suffering from heartburn, you have to inform your patients to:
- Limit the coffee and alcohol intake
- Cease smoking
- Lessen meat in the diet
As for medication, GERD patients are given Tums or anti-acids to decrease and neutralize acid production and preventing it from creeping up into the esophagus.
Gastritis and Peptic Ulcer
Gastritis merely is the inflammation of the lining of your stomach. In GERD, it’s about the lining of the esophagus, whereas with gastritis, it’s focused on the mucous membrane of the stomach that is gradually being eroded by too much acid. Because of this, patients who have gastritis experience severe stomach pain.
However, if the acid becomes increasingly high, that’s when ulcer or peptic ulcer occurs. Peptic ulcer is just a fancy term meaning the acid has eaten away or broken down the lining of the stomach, causing a hole or a tear. When this happens, the patient will start to bleed out due to the corrosion caused by the acid on the lining of the stomach.
Prevention and Treatment
With GERD patients, anti-acids are given to neutralize the condition.
With gastritis, the goal is to protect the lining of the stomach. Therefore the parietal cells that are responsible for acid production inside the stomach must be blocked or stopped which is why H2 blockers are administered. H2 blockers block the histamine production of the inflammatory response of the gastric lining. In a way, H2 blockers protect the stomach from ulcers.
Aside from H2 blockers, patients with gastritis are given proton pump inhibitors (PPI). Proton pump inhibitors aids in decreasing secretions inside the GI tract.
The Difference between Medications
Proton pump inhibitors work longer than anti-acids; their duration is similar to Lantus, a kind of long-acting insulin. PPIs can provide almost 24 hours of protection, which is not going to be effective in acute situations like GERD. Therefore, if your patients have GERD and you administered a PPI, the effects won’t be immediate. On the other hand, if you give anti-acids on your patients with GERD, the outcome would be quick, much like rapid-acting insulin that is frequently used for diabetic patients.
The analogy of these GI disorder medications is also similar to asthmatic patients. If they use an albuterol inhaler, the effects are immediate; whereas, if they use a steroid, it will take time for the effects to be experienced.
Remember, if you have a GERD patient, instant neutralization is important; therefore, you give anti-acids. PPIs and H2 blockers are like Lantus for diabetes or steroids for asthma – their effects are not immediate but have longer duration and effects. Basically, what PPIs and H2 blockers do is decrease secretions created by the GI tract to prevent gastric lining irritation and peptic ulcer disease.
At SimpleNursing.com, PPIs and H2 blockers have been included in the Pharmacology Boot Camp. Here, Mike has elaborately explained and have given depth to the effects the said medications.
If you want to know more about those medications or just want to find out about other useful nursing information, drop by SimpleNursing.com.