Disorders of the Gastrointestinal System, 2nd Edition
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EVIDENCE-BASED PRACTICE ALERT Patients with asthma experience an in- creased incidence of GERD. Research also has shown that GERD exacer- bates existing asthma. Nerves in the lower part of the esophagus connect to nerves in the lungs, causing acid reflux to trigger asthma symptoms. People with both asthma and GERD may find that treating GERD can help reduce their asthma symptoms and use of asthma medication. (American Academy of Allergy, Asthma, and Im- munology [AAAAI], 2022). Data have shown that 25%–40% of in- dividuals in the U.S. report symptoms of GERD at some time, and 7%–10% report that they experience symptoms daily. The actual percentages may be even high- er because many people self-medicate with over-the-counter (OTC) preparations and never report symptoms (Patti, 2021). GERD tends to be chronic, with relapse common, and long-term medication main- tenance therapy may be required. GERD is often considered an adult problem with increased risk over 40 (Patti, 2021); how- ever, studies show that GERD is common in infants and children. Repeated vomit- ing, coughing, irritability or colic, and re- spiratory problems may indicate GERD in this young population. Most infants will have a resolution of their GERD by age six months without any treatment, as the infant is typically able to sit and eat some solid foods by this time, and the lower esophageal sphincter has matured. By the age of ten months, 90% of cases see full resolution (Schwartz, 2019).
CASE STUDY 3 Mrs. Dasher is a 75-year-old retired bi- ology teacher. She has taken verapamil (Calan, a calcium-channel blocker) and a low-dose aspirin daily since a mild heart attack five years ago. She is also being treated for asthma, which has worsened since she contracted COVID-19. During a routine doctor’s visit, Mrs. Dasher men- tions that she has been suffering from severe “heartburn” for the past several months, “especially after my fourth or fifth cup of coffee.” Mrs. Dasher needs to be evaluated for GERD. Question All of the following are risk factors for the development of GERD EXCEPT: a. Aspirin use. b. Excessive coffee consumption. c. Asthma. d. History of heart attack. Answer/Rationale: The correct answer is d. Aspirin use, excessive caffeine, and asthma contribute to GERD’s development. A history of heart attack does not contribute to the risk of GERD. Gastroesophageal reflux disease (GERD) Often referred to as heartburn, GERD is the backflow of gastric or duodenal con - tents into the esophagus past the low- er esophageal sphincter (LES; Kahrilas, 2022). GERD is often dismissed as a mi- nor annoyance. However, ongoing reflux may cause inflammation of the esoph - ageal mucosa and result in esophageal ulcers, strictures, or Barrett’s esophagus (Kahrilas, 2022). All reports of heartburn must be carefully evaluated.
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