Understanding Gastroesophageal Reflux Disease (GERD): Explaining the Causes to the Patient

QUESTION

Scenario 2: Gastroesophageal Reflux Disease (GERD)

A 44-year-old morbidly obese female comes to the clinic complaining of  “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. She says she has started coughing at night which has been interfering with her sleep. She denies palpitations, shortness of breath, or nausea.

PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m²)

FH:non contributary

Medications: Lisinopril 10 mg po qd, Bentyl 10 mg po, ibuprofen 800 mg po q 6 hr prn

SH: 20 PPY of smoking, ETOH rarely, denies vaping

Diagnoses: Gastroesophageal reflux disease (GERD).

Question:

1.     If the client asks what causes GERD how would you explain this as a provider? 

ANSWER

Understanding Gastroesophageal Reflux Disease (GERD): Explaining the Causes to the Patient

Introduction

Gastroesophageal Reflux Disease (GERD) is a common digestive disorder that affects millions of individuals worldwide. Providing accurate and comprehensive information about the causes of GERD is essential for patient education and empowerment. In this scenario, a 44-year-old morbidly obese female presents with typical symptoms of GERD, and as a healthcare provider, explaining the causes of GERD in a clear and patient-friendly manner is crucial to facilitate understanding and management.

Explaining the Causes of GERD to the Patient

Gastroesophageal Reflux Disease (GERD) occurs when stomach acid and partially digested food flow backward from the stomach into the esophagus. This happens due to a weakened or malfunctioning ring of muscle called the lower esophageal sphincter (LES), which acts like a valve between the stomach and the esophagus. There are several factors that can contribute to the weakening of the LES and the development of GERD.

Lifestyle Factors: I would explain to the patient that certain lifestyle habits, such as being overweight or obese, smoking, and consuming alcohol, can increase the risk of GERD. Excess weight, especially around the abdomen, can put pressure on the stomach and LES, leading to acid reflux.

Dietary Choices: I would discuss how certain foods and beverages, including spicy, fatty, and acidic foods, as well as caffeine and carbonated drinks, can relax the LES and trigger acid reflux. I would emphasize the importance of maintaining a balanced diet and avoiding trigger foods.

Hiatal Hernia: I would explain that a hiatal hernia, which occurs when a portion of the stomach pushes up through the diaphragm and into the chest, can also contribute to GERD. This condition can affect the normal functioning of the LES and increase the risk of acid reflux.

Pregnancy: For female patients, I would mention that pregnancy can put pressure on the abdomen and LES, leading to GERD symptoms. However, I would reassure the patient that GERD symptoms related to pregnancy often improve after childbirth.

Medications: I would discuss how certain medications, such as antihypertensives like Lisinopril and pain relievers like ibuprofen, can relax the LES and contribute to GERD symptoms. I would emphasize the importance of discussing medication use with a healthcare provider.

Other Medical Conditions: I would explain that certain medical conditions, such as irritable bowel syndrome, can be associated with an increased risk of GERD. Additionally, family history and genetics may play a role in the development of GERD.

Conclusion

As a healthcare provider, it is crucial to provide patients with a clear and comprehensive understanding of the underlying causes of Gastroesophageal Reflux Disease (GERD). By explaining how lifestyle factors, dietary choices, medical conditions, and other factors contribute to the weakening of the lower esophageal sphincter (LES), patients can make informed decisions about managing their symptoms and reducing the risk of complications. Effective patient education empowers individuals to take an active role in their own health and well-being, leading to improved outcomes and a better quality of life.