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Gastrointestinal Tract: Disorders of Motility Essay

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Updated: Jul 20th, 2021

Introduction

The diseases that affect the stomach have some similarities in their clinical presentation and pathophysiology. Such conditions as gastroesophageal reflux disease (GERD), gastritis, and peptic ulcer disease (PUD) are often interconnected, with one of them resulting in or affecting the other. The changes that these disorders cause relate to acid production, and especially its normal process of secretion. The normal production of gastric acid is based on numerous stimuli, three main phases (cephalic, gastric, and intestinal), the Intrinsic factor, and the state of the parietal cells (Huether & McCance, 2017).

Some patient factors also influence the pathophysiology of these conditions – gender, while not being the most significant contributor to the diseases, affects people’s presentation and prevalence of GERD, PUD, and gastritis. Therefore, the diagnosis and treatment of these patients also depend on gender differences. GERD, PUD, and gastritis are diseases that manifest themselves through the problems of gastric acid production. Female patients may have more serious symptoms than male ones, but men can suffer from these diseases for a longer time than women.

Normal Pathophysiology

Normal acid secretion and production happen in three main steps. The first one is the cephalic phase, during which the person’s gastrointestinal system is stimulated by the thought of food, smells, and tastes (Huether & McCance, 2017). The next phase is gastric – the process of consuming food that distends the stomach. The stomach starts the process of secretion after gastrin, histamine, somatostatin, acetylcholine, and other chemicals are activated. The central component of all gastric secretions is hydrochloric acid. It is produced in the parietal cells which perform it using hydrolysis of water (Huether & McCance, 2017).

Acetylcholine causes the secretion of gastrin, which, in turn, leads to the production of histamine. Histamine activates the receptors and influences the work of the parietal cells (Huether & McCance, 2017).

Changes

Major alterations to the pathophysiological processes in the stomach cause the discussed gastrointestinal tract disorders. In the case of PUD, the use of NSAIDs (nonsteroidal anti-inflammatory drugs) by the patient or the infection of H. pylori erode the mucosal lining of the stomach and, thus, decreases its protective features (Hammer & McPhee, 2014). As acid is a corrosive agent, it damages the lining and leads to the formation of the ulcer.

The pathogen of H. pylori and the use of drugs also play a significant role in the development of gastritis as well. Gastritis is characterized by the inflammation of the stomach’s lining that can lead to ulcers, meaning that the two conditions are connected (Sipponen & Maaroos, 2015). Many causes of GERD exist, but their effect is similar – they lead to the failure of the lower esophageal sphincter that protects the esophagus from acid (Hammer & McPhee, 2014). The absence of this barrier leads to the acid flowing into the esophagus, which causes a burning feeling in a person’s chest.

Patient Factor

Gender, especially some genetic and hormonal differences, has an impact on the pathophysiology of these disorders. According to Kim, Kim, and Kim (2016), the symptoms of reflux are more prevalent in women than in men. However, the authors suggest that estrogen works as an anti-inflammatory agent, delaying severe pathological changes in the patient’s body (Kim et al., 2016). Therefore, male patients may suffer from complications of GERD more frequently than females. The hormone is also suspected to act as a relaxant, opening the lower esophageal sphincter and causing GERD symptoms to appear (Kim et al., 2016).

Chung et al. (2015) also notice a difference in the development of gastritis in male and female patients. According to the scholars, women’s symptoms are connected to epigastric pain, revealing a correlation with the previous study and suggesting that female hormones affect the muscles of the tract (Chung et al., 2015). It is possible that the occurrence of PUD may also be dependent on these factors.

The differences described above should be taken into consideration by health care providers. According to the studies, women have a higher susceptibility to GERD-related symptoms, suggesting that their diagnostic process may be easy with endoscopy, tests for bacteria, and x-ray. However, they may not respond to medical treatments as effectively because of estrogen’s effect. Both patients may benefit from surgery that strengthens the esophageal sphincter. The diagnosis of gastritis and ulcers should also be focused on finding the symptoms – women’s prevalence of epigastric pain should be acknowledged and treated accordingly with antacids, antibiotics, and acid production blockers (Huether & McCance, 2017).

Conclusion

Gastrointestinal tract disorders are strongly influenced by the production of acid and its movement out of the stomach. In the case of GERD, acid flows out of the stomach and affects other parts of the tract. In gastritis and PUD, acid affects the lining of the stomach due to its lowered protection. All disorders may manifest themselves differently in male and female patients. Women can have symptoms that are more pronounced, while men may suffer from more serious complications.

Mind Map of Gastritis

Mind Map of Gastritis

References

Chung, S. H., Lee, K. J., Kim, J. Y., Im, S. G., Kim, E., Yang, M. J., & Ryu, S. H. (2015). Association of the extent of atrophic gastritis with specific dyspeptic symptoms. Journal of Neurogastroenterology and Motility, 21(4), 528-536.

Hammer, G. D., & McPhee, S. J. (2014). Pathophysiology of disease: An introduction to clinical medicine (7th ed). New York, NY: McGraw-Hill Education.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Kim, Y. S., Kim, N., & Kim, G. H. (2016). Sex and gender differences in gastroesophageal reflux disease. Journal of Neurogastroenterology and Motility, 22(4), 575-588.

Sipponen, P., & Maaroos, H. I. (2015). Chronic gastritis. Scandinavian Journal of Gastroenterology, 50(6), 657-667.

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IvyPanda. (2021) 'Gastrointestinal Tract: Disorders of Motility'. 20 July.

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