Gastroesophageal Reflux Disease: A Case Study Analysis

This presentation provides a medical synopsis of a patient with Gastroesophageal Reflux Disease (GERD) and analyzes their case history, identifying the problem and potential long-term effects. It also discusses goals and modifications in lifestyle, drug therapies, and a complete treatment plan for GERD patients. The efficacy and toxicity of selected drug regimens are also discussed, along with educating the patient about GERD therapy and additional questions to consider.

GASTROESOPHAGEAL
REFLUX DISEASE
-brief analysis of a case study

MEDICAL SYNOPSIS OF THE PATIENT
 Name- Janet Swigel
 Age-68 year old
 Symptom is regurgitation after having meal and acidic
taste in the mouth.
 Difficulty in sleeping
 Symptoms are worst at night.

CASE HISTORY
PMH
Atrial fibrillation from last 12 years
Asthma from last 10 years
Type 2 DM from last 5 years
HTN from last10 years
SH
Consumes alcohol for 4-5 days per week.
She is having prescribed drug insurance
FH
Her mother died at the same age with
gastric cancer.
The patient is over weighted and her
blood pressure is also high. Previous
lab examinations revealed the
patient is having Grade B
Esophagitis. Biopsy result is
negative. The main question is, why
the patient is having a lot of
heartburn especially at night even
after some treatment.

IDENTIFYING THE PROBLEM
 The patient is taking aspirin on a daily basis and the main problem is self-treatment.
 She is having heartburn 4-5 times a week and along with regurgitation after meal,
she feels acidic taste in her mouth.
 She cannot sleep at night
 After taking OTC Prevacid 24HR for 3 weeks daily, the heartburn reduced but still
it happen 3-4 times a week which is alarming and bothering the patient also.
 Her intake of alcohol can be a factor of GERD (Buendgens, Koch, & Tacke, 2016).

LONG TERM AFFECT OF GERD
 If this is kept untreated for a long period then heartburn may result in esophageal
cancer also which was the partial reason of her mother’s death at this same age (De
Bortoli et al., 2014).
 Narrowing of esophagus can also cause which leads to heart attack (Kim et al., 2015).
 Patients are randomly assigned to comparison groups in community pharmacy setting.
Empiric drug therapy is done if the perfect information is absent and it is done based
on experience only (Lué & Lanas, 2016). So, if her symptoms are still appearing then I
should refer her for further diagnostic evaluation instead of empiric drug therapy.

GOALS AND MODIFICATION IN
LIFESTYLE
 The patient should never use self-treatment procedure.
 She should leave her consumption of alcohol which she
is taking 4-5 days a week.
 Janet should complete her meal 2-3 hours before going
to bed at night.

DRUG THERAPIES TO TREAT THIS
PATIENT’S GERD SYMPTOMS
 Antacids are helpful in neutralizing gastric acid
(KUMAR, Gandhi,& Harsha, 2016).
 PPIs are most effective medical therapy to treat GERD
(Lambert et al., 2015).
 PPI helps to block the mechanism that produces harmful
acid in stomach (Lee et al., 2014).

COMPLETE TREATMENT PLAN FOR
GERD PATIENT
 Diagnosis of GERD is based on the history of patients.
 PPI is very much effective and it should be taken regularly
before the first meal of the day (Lué & Lanas, 2016).
 Drug selection should always be based on the symptoms of
patients.
 For this patient antacid is not working properly so PPI is the best
solution.

EFFICACY AND TOXICITY OF
SELECTED DRUG REGIMEN
 PPIs are very much effective in managing GERD.
 There are some adverse effects of long-term use too.
 Development of pneumonia, drug interaction and
dementia is possible (Penagini et al., 2015)
 Emphasizing appropriate dosing is highly
recommendable (Walker & Flint, 2016).

EDUCATING THE PATIENT ABOUT
GERD THERAPY
 Educating a patient of GERD is highly necessary.
 The problem becomes a big issue when self-medication process
is associated (Scarpignato, Gatta, Zullo, & Blandizzi, 2016).
 Over dose of antacids or PPI can be harmful too.
 There is need of lifestyle management also.
 Patient should be educated how to live a life and they should be
convinced to visit a doctor whenever required.

SOME ADDITION QUESTIONS TO BE
CONSIDERED
 How heredity is associated with the Janet’s case as her mother also died
from esophageal cancer.
 She was informed that overdose of calcium can create osteoporosis and
nasty infections too.
 After medication of four months she left and still suffering from heartburn
although reduced.
 She is concerned that for how long she needs to stay under medication.
 If lifestyle management is not done then medication cannot help the patient.

WORKS CITED
Buendgens, L., Koch, A., & Tacke, F. (2016). Prevention of stress-related ulcer bleeding at the intensive care unit: Risks and
benefits of stress ulcer prophylaxis. World journal of critical care medicine, 5(1), 57.
De Bortoli, N., Martinucci, I., Savarino, E., Bellini, M., Bredenoord, A. J., Franchi, R., ... & Marchi, S. (2014). Proton pump
inhibitor responders who are not confirmed as GERD patients with impedance and pH monitoring: who are
they?. Neurogastroenterology & Motility, 26(1), 28-35.
Kim, S. E., Kim, N., Oh, S., Kim, H. M., Park, M. I., Lee, D. H., & Jung, H. C. (2015). Predictive factors of response to proton
pump inhibitors in Korean patients with gastroesophageal reflux disease. Journal of neurogastroenterology and motility, 21(1),
69.
KUMAR, D. N. R., Gandhi, M. V. V., & Harsha, G. S. (2016). GERD CORRELATION BETWEEN CLINICAL SYMPTOMS
AND ENDOSCOPIC FINDINGS-STUDY IN 200 PATIENTS. Dysphagia, 4, 2.
Lambert, A. A., Lam, J. O., Paik, J. J., Ugarte-Gil, C., Drummond, M. B., & Crowell, T. A. (2015). Risk of community-acquired
pneumonia with outpatient proton-pump inhibitor therapy: a systematic review and meta-analysis. PloS one, 10(6), e0128004.

WORKS CITED
Lee, S. W., Lien, H. C., Lee, T. Y., Yang, S. S., Yeh, H. J., & Chang, C. S. (2014). Heartburn and regurgitation have different
impacts on life quality of patients with gastroesophageal reflux disease. World Journal of Gastroenterology: WJG, 20(34), 12277.
Lué, A., & Lanas, A. (2016). Protons pump inhibitor treatment and lower gastrointestinal bleeding: balancing risks and
benefits. World journal of gastroenterology, 22(48), 10477.
Penagini, R., Sweis, R., Mauro, A., Domingues, G., Vales, A., & Sifrim, D. (2015). Inconsistency in the diagnosis of
functional heartburn: usefulness of prolonged wireless pH monitoring in patients with proton pump inhibitor refractory
gastroesophageal reflux disease. Journal of neurogastroenterology and motility, 21(2), 265.
Scarpignato, C., Gatta, L., Zullo, A., & Blandizzi, C. (2016). Effective and safe proton pump inhibitor therapy in acid-
related diseases–A position paper addressing benefits and potential harms of acid suppression. BMC medicine, 14(1), 179.
Walker, A. W., & Flint, H. J. (2016). further evidence that proton pump inhibitors may impact on the gut microbiota.
Alimentary pharmacology & therapeutics, 43(10), 1104-1105.