Gastrointestinal Tract: Disorders of Motility

Gastrointestinal Tract: Disorders of Motility

Normal Pathophysiology of Gastric Acid Stimulation and Production:

The stomach produces gastric acid in order to break down food products into necessary vitamins and eventual waste product; this is the normal function and when there is not a medical issue to prevent or inhibit the acids from performing their proper job, there are no negative consequences for its existence. There are three stages of gastric acid stimulation and production in a normally-functioning body. First there is the cephalic phase where thought, taste, smell, or sight of food begins acid stimulation. These processes incite the gastrointestinal tract to begin producing the acid and secreting it into the stomach so that the food that is eventually consumed can be broken down. Then, begins the gastric phase where the chemicals within food are distributed into the stomach. When the food hits the stomach, it is met by hydrochloric acid which has already been secreted. The food is dissolved by the acid and broken down into its essential components. Finally, during the intestinal phase the final bits of acid are secreted in response to the consumption of a meal. As the food content travels through the gastrointestinal tract, it is further broken down into either nutrients or waste matter. The level of acid produced is usually in direct correlation to the size of the meal and the content of the food products consumed. Acid and pepsin are created within the stomach which itself has mechanisms designed to protect the organs and inner body from the caustic nature of the substances produced (Soll 2013). These defenses and healing mechanisms are controlled by neural, endocrine, paracrine, and autocrine paths within the human body, provided all mechanisms are functioning properly.

Changes that Occur to Gastric Acid Stimulation and Production with GERD, PUD, and Gastritis Disorders:

When a person has issues with their gastrointestinal tract because of GERD, PUD, or Gastritis conditions, there are actually changes that occur with regard to acid stimulation and production. In some cases, the stimulation of the gastrointestinal tract produces too mucho f the gastric acid; too much of this makes it impossible for the body to function normally and the acid, having already destroyed the food products for which they were created, begin attacking the actual body. In GERD patients, the acid that is produced is refluxed by the body into the esophagus which can cause a great deal of discomfort. According to Kahrilas (2003), "Once reflux has occurred, impaired acid clearance prolongs exposure of the mucosa to the damaging effects of the refluxate" (page S7). Acid is secreted into body parts which are not prepared for it and has not been designed to defend itself against the damage this acid can cause (Kahrilas 2003,-page S5). PUD (peptic ulcer disease) is diagnosed when a patient has gastric, duodenal, or esophageal ulcers which are most often caused by a bacterial infection of Helicobacterpylori or H. pylori. Usually PUD is caused by hypersecretion of hydrochloric acid or pepsin which the body is unable to protect itself against (Peters 2010). The body defenses, including mucosal barriers are overridden and the acid enters parts where there are no defenses, releasing histamines which then produce additional acids eventually creating lesions in the locations where the body is attacked by its own acid production. The dysfunction within the body that leads to gastrointestinal disorders such as GERD, PUD, and gastritis can be anywhere along the gastrointestinal tract. Many, for example, experience lower esophageal sphincter dysfunction wherein an increase in the proportions of TSLERS ("decreased LES resting tone, impaired esophageal acid clearance, delayed gastric emptying, decreased salivation, and impaired tissue resistance") is accompanied by the reflux already described (Kahrilas 2003,-page S6). Any of these aspects can be singular or combined with any or several of the others. There can also be changes to the ways in which the body defends itself against these acidic secretions; increased acid exposure can seriously damage or even destroy portions which are given undo exposure. For example, in some patients, the stomach is unable to defend itself from the caustic nature of the acid, which creates lesions in the lining, called gastric ulcers.

How Age Might Impact the Pathophysiology of GERD, PUD, and Gastritis?

GERD:

Most patients with GERD suffer from symptoms of other conditions such as Irritable Bowel Syndrome (IBS) which produces pain, abdominal distress, and the need for frequent bowel movements (Gasiorowska 2009,-page 1829). GERD is more prevalent with patients who are over the age of forty although it has been found in patients much younger than this. Pregnant women or those who have other medical conditions related to the gastrointestinal tract, such as diabetes or hiatal hernia, are more likely to develop GERD. Age is a major factor as some of the preconditions for GERD such as slower stomach emptying come naturally age. There are three tests which have been traditionally used to diagnose the condition: pH monitoring to test for acid over a 24 or 48-hour period, endoscopy, or manometry. Unfortunately, GERD is a chronic condition without a cure, but there are ways of managing it including over the counter antacids and lifestyle changes. There are prescriptions available for severe cases. In the most extreme cases, surgery can be performed to suppress the acid producers.

PUD:

Like GERD, PUD tends to be found in older patients; in this case PUD is very rare in patients under the age of 60. Less than 10% of patients are aged 20. It is believed that the reason for this is that while 50% of all people have some H. pylori bacteria within their bodies in their lifetime, only 5-10% will become the victims of PUD and the more fragile the body at the time of infection, the greater the likelihood to develop PUD (Kulber 1990,-page 737). Testing for PUD first requires testing for the presence of H. pylori which is can be done with a blood, stool, or breath test. An endoscopy or x-ray of the digestive system will also show whether a peptic ulcer exists. To treat the PUD, the patient should first be given antibiotics to kill the H. pylori. Acid blockers such as prilosec or prevacid are given either in over-the-counter or prescription medications. Antacids are also given as they neutralize stomach acid and prevent the chemical compounds from causing pain. There are also medicines which protect the stomach lining and small intestine from being further deteriorated by the acid.

Gastritis:

Older people have a higher risk of developing gastritis as with the other conditions because of the thinning of the stomach lining over time (Wehbi 2013). In addition, patients over the age of 60 are more likely to develop autoimmune disorders or to have trouble naturally fighting off bacteria like H. pylori. As with PUD, gastritis is diagnosed first through tests to detect H. pylori. From there, the doctor can perform an endoscopy or an x-ray of the upper digestive system to look for signs of the condition. Once it is diagnosed, acid blockers are prescribed, as are antacids and medications to reduce outright acid production.

Works Cited

Gasiorowska, A., Poh, C.H., & Fass, R. (2009). Gastrointestinal reflux disease (GERD) and irritable bowel syndrome (IBS) -- is it one disease or an overlap of two disorders? Digestive Diseases and Sciences. Springer. 54(1829). 1829-34.

Kahrilas, P. (2003, November). GERD pathogenisis, pathophysiology, and clinical manifestations. Cleveland Clinical Journal of Medicine. 70(5). S4-S19.

Kulber, D.A., Hartunian, S., Schiller, D., & Morgenstern, L. (1990, December). The current spectrum of peptic ulcer disease in the older age groups. The American Surgeon. Southeastern Surgical Congress: Atlanta, GA.

Peters, G., Rosselli, J., & Kerr, J. (2010). Overview of peptic ulcer disease. Jobson Publishing.

Soll, A.H. (2013). Physiology of gastric acid secretion. Ed. M. Feldman. Wolters Kluwer.

Wehbi, M. (2013). Acute gastritis. Ed. J. Katz.