The primary symptoms of GERD are usually heartburn, weight loss, and burning pain at epigastric area. To further confirm the diagnosis, Mike should be examined if he exhibits symptoms such as regurgitation, hoarseness or sore throat, lump in his throat, or an acid taste in his mouth (Richter & Rubenstein, 2018). Sudden increase in saliva, dry cough, laryngitis, difficulty in swallowing, or black stools are also considered symptoms of GERD. Some laboratory test results can also confirm the presence of the disease. For instance, an upper endoscopy examination can be done to check the conditions of esophagus and stomach. Presence of inflammation on the linings can confirm the diagnosis (Richter & Rubenstein, 2018). If ambulatory acid (PH) test shows an element of acid reflux, then GERD can be confirmed. Through esophageal manometry, the performance of esophageal sphincter valve between stomach and esophagus can be assessed. Muscle contraction and pressure exerted on the two organs can further be used to monitor the condition of the patient. If malfunctions are detected, then presence of the disease is confirmed.
Differential diagnoses for a patient exhibiting epigastric pain are many owing to the fact that this symptom is associated with other digestive conditions. For instance, cardiovascular problem such as chest pain or angina due to the lack of oxygen can cause a burning pain in the epigastric areas. Lactose intolerance condition caused by inadequate production of lactase enzyme can also result in stomach pain or gas pressure in the abdomen as sugar elements from dairy products fail to be broken down (Indiran et al., 2018). The excessive consumption of alcohol can cause inflammation and bleeding of stomach linings leading in severe pain. Peptic ulcer condition caused by destruction of small intestine as a result of bacterial infections or taking NSAIDs can also cause epigastric pain (Indiran et al., 2018). Gastritis caused by stomach damage or inflammation also exhibits symptoms of esophagus discomforts. Esophagitis condition caused by infections, allergies, or irritation from medications can result in abdominal pain.
Some pathogens can cause infectious diseases resulting in epigastric pains. For the case of peptic ulcer, bacterial infections can damage stomach or small intestine lining leading in severe pain. Esophagitis disease caused by Fungi, yeast, viruses, or bacteria can result in swelling and irritation of stomach (Correia & Morgado, 2017). Similarly, Gastritis is caused by both fungal and bacterial infections can lead to inflammation of mucosa. When a clinician is faced with any of the conditions above especially GERD, the most desired treatment outcome is always a positive response to pharmaceutical therapy. Patient is expected to regain normal body weight and feel minimal or zero epigastric pain.
Not all patients respond well to pharmaceutical or surgical therapy, some react positively to non-pharmaceutical treatments. Mike can alter his eating habits by taking food in small bits but frequently to avoid reflux in esophagus. He should evade some food capable of triggering reflux such as spicy foods, tomatoes, onion or garlic. Coffee should be avoided since it increases acid production which can cause mucosal irritations (Ness-Jensen et al., 2016). Little exercise or staying up for three hours after eating can ensure acid remains in the stomach as required, meaning, patient should avoid taking naps immediately after meals or midnight snacks. If Mike is either alcoholic or a smoker, he should cut back on consumption of the former or nicotine. This is due to fact that alcohol damages digestive system, hence, can cause ulcers or irritations (Ness-Jensen et al., 2016). Fibers enhances bowel functions, digestion, absorption and makes fecal elimination easier and quicker. Consumptions of foods rich in fiber also increases chances of desired treatment outcomes especially for pathologies.
Cow’s milk proteins usually overlap with GERD in children and this can cause regurgitation. Therefore, when designing a pharmaceutical plan for infants, they should avoid consumption of milk. For the obstetrics, belly fats always insert pressure on the stomach causing epigastric pain. Apart from medications, treatment plan should involve physical exercise, eating in bits and slowly, and avoidance of foods which can worsen the condition. Elderly patients exhibit higher tolerance to GERD symptoms and are mostly to show atypical signs. They have reduced esophageal motility, peristalsis, and sensation leading in lack of symptoms (Ivashkin et al., 2017). Some have higher possibility of symptomatic relapse especially after administration of proton pump inhibitor (PPI). Therefore, cares such as trial of PPI, conducting upper endoscopy tests, and frequent evaluation should be done.
The normal pharmaceutical plan for a GERD patient such as Mike should consist of the following. First, antacid such as gaviscon should be taken at 2 tablets 4 times a day especially 30 to 60 minutes after meals with a glass of water. It buffers and neutralizes gastric acid in the esophagus and stomach increasing digestion of food and reduction of heartburn (Ivashkin et al., 2017). The dosage should be administered until symptoms starts to subside. Second, H2 blockers, for instance, nizatidine (Axid), should be taken at 300mg once a day during bedtime for a period of 8 weeks. It helps in healing the esophagus in case of damage or irritation (Ivashkin et al., 2017). The medication for GERD is usually a PPI such as pantoprazole. It heals damages in esophagus and stomach linings, reduce occurrence of erosive esophagitis (EE), and secretion of acid in the body. PPI should be taken at 40mg once a day at bedtime with glass of water. This should be done 30 to 60 minutes after meal time for a period of 8 weeks. If symptoms persist for another 8 weeks’, treatment plan should be administered.
Although the treatment plan above is considered the most effective and the safest, some of the agents above exhibit side effects. Antacids are known to cause vomiting, diarrhea, or constipation in patients. PPIs can cause headache, diarrhea, and stomach upset. Research by some experts have also revealed pantoprazole can cause Clostridioides difficile infection (Ivashkin et al., 2017). H2 blockers also cause headaches, diarrhea, fatigue, abdominal pain, confusion, coughs or breathing difficulties.
Upon administering the pharmaceutical therapy, caregiver should monitor how the patient is responding to the treatment. One way of doing this is through assessment of the severity of heartburn at daytime and nighttime especially after meals. Using daily study diary entries, the severity of the acid reflux can be recorded as none, mild, moderate, severe, or very severe. In case of the latter or severe, patient should be put into another treatment plan of 8 weeks.
As Mike’s doctor, I would advise him to stick to the prescribed dosage and if he is not capable to manage his time well, I would encourage his caretaker to help when necessary. This is due to fact that 8 weeks’ treatment plan is a long period of time and one may fail to adhere to the timelines. Both antacid and PPIs may cause abdominal pain, diarrhea, or fatigue, therefore, Mike should monitor the severity of these side effects and report to the doctor immediately in case of persistence. The main cause of epigastric pain is the accumulation of acids in the upper abdomen. Thus, the patient should avoid foods high in fats, alcohol, smoking, and take foods rich in fiber.
References
Correia, P. C., & Morgado, B. (2017). Caroli’s disease as a cause of chronic epigastric abdominal pain: Two case reports and a brief review of the literature.Cureus, 9(9), 1-11. Web.
Indiran, V., Dixit, R., & Maduraimuthu, P. (2018). Unusual cause of epigastric pain: Intra-abdominal focal fat infarction involving appendage of falciform ligament-case report and review of literature.GE-Portuguese Journal of Gastroenterology, 25(4), 179-183. Web.
Ivashkin, V.T., Mayev, I.V., Trukhmanov, I.A., Baranskaya, Y.K., Dronova, O.B., Zayratyants, O.V., Sayfutdinov, R.G., Sheptulin, A.A., Lapina, T.L., Pirogov, S.S., & Kucheryavy, Y.A. (2017). Diagnostics and treatment of gastroesophageal reflux disease: Clinical guidelines of the Russian gastroenterological association. Russian Journal of Gastroenterology, Hepatology, Coloproctology, 27(4), 75-95. Web.
Ness-Jensen, E., Hveem, K., El-Serag, H., & Lagergren, J. (2016). Lifestyle intervention in gastroesophageal reflux disease.Clinical Gastroenterology and Hepatology, 14(2), 175-182. Web.
Richter, J. E., & Rubenstein, J. H. (2018). Presentation and epidemiology of gastroesophageal reflux disease.Gastroenterology, 154(2), 267-276. Web.