Brief Discussion of Acid Reflux Disease, Pathophysiology and Treatment Regimens (Essay Sample)

Acid reflux
Student’s name
Institutional Affiliation
Acid reflux
Pathophysiology
Acid reflux disease is also known as gastro-esophageal reflux disease (GERD). It is characterized by a reflux and regurgitation of acidic contents of the stomach into the esophagus (Brunner, Suddarth & Smeltzer, 2012). The pathophysiology of the disease is related to the mechanical causes that affect the lower esophageal sphincter’s ability to close tightly and allow a significant amount of the gastric contents that cause symptoms. The defective anatomical structure of the sphincter such as abnormally shortened length and inability to relax while swallowing and contract in the absence of swallowing allows the gastric acids into the esophagus. Additionally, increased gastric volume and intra-abdominal pressure due to delayed gastric emptying attributed to reduced intestinal motility and other pathologies may also lead to the regurgitation of some acidic contents into the esophagus through the lower esophageal sphincter. In normal anatomy, the gastroesophageal sphincter junction is located at the crus which act as an extrinsic sphincter and aid the proper functioning of the sphincter. In instances of a hiatal hernia, these synergistic actions are lost, and the reflux of the gastric contents is promoted. Moreover, some foods and drugs and hormones such as the coffee, alcohol, and calcium channel blockers, beta blockers, and progesterone which reduce the contractility of lower esophageal sphincter. Under any one of these mechanisms, the gastric contents are regurgitated into the esophagus and cause esophagitis. The esophagus normally has a protective mucus layer which is continuously worn out with the prolonged exposure to acidic gastric contents. Its peristaltic ability is consequently impaired due to the injury on its smooth muscles leading to reduced esophageal clearance. This thus exacerbates the condition, and its symptoms begin to be exhibited. Other factors that may contribute to the rapid progress of the disease include smoking, alcohol intake, obesity and intake of drugs that reduce muscle tone (Brunner, Suddarth & Smeltzer, 2012).
Medication
Treatment of GERD involves a combination of several drugs that act to reduce regurgitation on the lower esophageal sphincter directly or indirectly. Some of them are meant to lower the acidity of the regurgitated gastric contents in order to reduce the continuous corrosion on the esophageal wall (Birk, 2012). H2 blockers such as cimetidine and ranitidine competitively bind to H2 histamine receptors leading to a reduction of the parietal cells intracellular concentrations of cyclic adenosine monophosphate whose level is determined by histamine binding to H2 receptors. Hence the secretion of gastric acid is significantly reduced. These drugs have an effect on the pathophysiology of GERD since with the reduction of gastric content acidity; the level of corrosion is also esophagus is lowered. On the other hand, reduced hydrochloric acid production meals the gastric content volume is also reduced, hence less intra-abdominal pressure which leads to less regurgitation. Likewise, proton pump inhibitors such as omeprazole and esomeprazole irreversibly block the gastric proton pump (H+/K+ ATPase), which is involved in the last stage of gastric secretion. This leads to less or no production of hydrochloric acid and therefore providing the same therapeutic effects as H2 blockers as well as antacid drugs which also reduce the acidity by neutralization (Smith, 2016).
Equally, prokinetic drugs such as metoclopramide can be used in severe GERD according to Smith (2016). Metoclopramide is a benzamide which acts as a 5-HT4 receptor agonist in the GI tract. It initiates the cholinergic transmission which in turn increase the intensity of peristaltic contraction of the lower esophageal sphincter contractions and consequently controlling reflux of gastric contents into the through it. However, like all prokinetics, this drug is not commonly used due to the adverse side effects that are associated with them which include tardive dyskinesia, sedation, and other neurological effects.
Some pharmacological and herbal remedies have been utilized in the treatment of reflux disease. For instance, Aloe Vera, herbal medicine is stipulated to assist in the t management of the illness because it provides a soothing effect on the already irritated esophageal lining. It contains polysaccharides and glycoproteins that contribute towards healing. The glycoproteins promote healing by preventing inflammation while polysaccharides stimulate wound healing and repair. Moreover, the companies that produce and commercialize Aloe Vera for the treatment of reflux disease claim that it should be taken even after the symptoms of the disease have ceased in order to reverse the effects caused by the disease. However, some of the patient safety issues are that it is known to be a strong laxative...