Gastrointestinal Disorder Introduction

In the digestive system, food travels down the esophagus and passes through the esophageal-gastric sphincter muscle. The esophageal-gastric sphincter muscle is a muscle that “clamps up” to prevent stomach contents and acid from traveling back into the esophagus. Another sphincter is located at the base of the stomach. 

Knowing the similarities and differences between these gastrointestinal disorders (GERD, gastritis, or peptic ulcer) and their related nursing interventions will help streamline client care (and your exams, of course).

GERD Pathophysiology

If acid production refluxes into the esophagus and “burns away” its membrane, you get gastroesophageal reflux disease (GERD) or heartburn. GERD clients are given antacids to neutralize the acid they produce and prevent it from back flowing into the esophagus.

Signs and Symptoms of GERD

GERD is often confused with heartburn, but it’s not the same. Nurses should be aware of these common signs and symptoms:

• Sour taste in the mouth
• Regurgitation (the feeling that food is coming back up)
• Difficulty swallowing
• Wheezing or difficulty breathing (due to inflammation of airways) 
• Indigestion
• Nausea and vomiting
• Chronic coughing (due to irritation of the esophagus and respiratory tract by stomach acid)
• Chest pain when lying down

GERD Causes

GERD can affect anyone at any age, but it is more common in people who are overweight or those with health conditions such as diabetes or hiatal hernia. This condition can also be familial (runs in families)

Here are some of the most common causes of GERD:

• Eating spicy foods 
• Drinking carbonated beverages
• Being overweight or obese
• Smoking cigarettes
• Taking certain medications (such as acid-suppressing drugs like Nexium and Prilosec)

GERD Treatment

Lifestyle Changes

• Weight loss
• Diet changes
• Over-the-counter (OTC) antacids
• Raise the head of bed to sleep

Medications

• Specific to the cause

Procedures

• Upper gastrointestinal endoscopy
• Esophagogastroduodenoscopy
• (EGD)

Surgery

The main goal is to tighten up the lower esophageal sphincter (LES).

• The Stretta procedure delivers radiofrequency energy waves through electrodes to tighten the LES.
• Fundoplication wraps the upper curve of the stomach (the fundus), around the esophagus and sews it shut. This helps it tighten this esophageal sphincter.

Gastritis Pathophysiology 

Gastritis is the inflammation of the stomach lining and can be acute (with short-term inflammation) or chronic (with long-term inflammation).

Gastritis is to the esophagus what a garden is to the stomach. And GERD is when it comes up in your mouth. Gastritis can lead to heartburn and sore throats, and GERD can cause ulcers associated with the overuse of aspirin.

Memory Trick

• Gastric ulcer = Gut pain with food
• Duodenal Ulcer = Don’t have pain with food

Gastritis Causes and Risk Factors

• H. Pylori bacteria
• NSAIDs
  •  Naproxen
  •  Indomethacin
  •  Ibuprofen
• Stress (prolongs the ulcer)

Peptic Ulcer Pathophysiology 

Too much acid leaks into the gastrointestinal system can cause a peptic ulcer. A peptic ulcer results from acid that has eaten away or broken down the lining of the stomach, causing a hole or tear. The corrosion caused by the acid on the stomach lining causes the client to bleed out.

Peptic Ulcer Disease (PUD) occurs when gastric acids erode the gastric lining creating open sores in the esophagus, stomach, or duodenum.

Signs and Symptoms of Peptic Ulcers

• Persistent abdominal pain (acute or chronic) or discomfort
• Nausea and vomiting
• Heartburn (aka acid indigestion)
• Loss of appetite for specific foods (especially those containing fats or alcohol)
• Pain in the upper abdomen (that may come and go)
• Bloating and gas
• Heartburn 
• Bloody stools 

Peptic Ulcer Causes and Risk Factors

Peptic ulcers are typically caused by lifestyle and diet: stress, eating spicy or acidic foods, drinking too much coffee or alcohol, and smoking cigarettes regularly. Less common causes include taking certain medications, infection with Helicobacter pylori bacteria, pregnancy, diabetes mellitus, or having an autoimmune disease.

These risk factors can increase the chances of developing peptic ulcers:

• Smoking cigarettes
• Drinking too much alcohol 
• Taking aspirin, ibuprofen, or NSAIDs
• Having a high fever for several days at a time
• Being underweight or overweight
• Eating a lot of spicy foods or drinking caffeine
• Having an injury to the abdomen (such as from an accident)

Prevention and Treatment of Gastritis and Peptic Ulcers

GERD clients can take antacids to neutralize their symptoms. However, gastritis sufferers are treated with drugs designed to protect the stomach lining and must have the parietal cells that produce acid secretion stopped. This is achieved using H2 blockers, which block histamine production. 

Clients with gastritis are prescribed H2 blockers and proton pump inhibitors (PPIs). H2 blockers protect against ulcers by preventing inflammation. PPIs decrease the amount of acid secreted by cells inside the intestines.

Gastritis vs Peptic Ulcer Medications

Proton pump inhibitors (PPIs) last longer than antacids. PPIs provide almost twenty-four hours of protection, which is ineffective for conditions like GERD.  The effects won’t be immediate if a client has GERD and is prescribed a PPI.

Treating a client with heartburn may not help immediately (but it’s important to prevent long-term complications). Antacids decrease stomach acids, but PPIs and H2 blockers reduce the amount of fluids secreted by the GI tract.

Here are gastritis and peptic ulcer drugs to remember:

• Antibiotics (H. Pylori bacteria)
  • Amoxicillin
  • Clarithromycin
  • Tetracycline
  • Metronidazole
  • Bismuth 
• Acid reducers
  • Antacids
  • Histamine receptor blockers
    •  Ranitidine
  • PPIs: Proton pump inhibitors
    •  Omeprazole
• Mucosal protectants
  • Sucralfate
  • Misoprostol

Gastrointestinal Disorder Conclusion

When acid refluxes up the esophagus and “burns away” its membrane, clients get heartburn or GERD — an uncomfortable condition that’s treated with antacids. Gastritis is the inflammation of the stomach lining, a condition that can be either acute or chronic. A peptic ulcer develops when stomach acid levels become too high.

Sources

https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223 

https://www.mayoclinic.org/diseases-conditions/gastritis/symptoms-causes/syc-20355807 

https://my.clevelandclinic.org/health/diseases/10349-gastritis 

https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940