Gastric Acid Stimulation and Production

Pathophysiology of gastric acid stimulation and production

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The parietal cells in the stomach are responsible for the production of gastric acid. Parietal cells contain secretory canaliculus, which produce gastric acid and release it into the gastric lumen. Gastric acid is produced as a response to the messages received through hormonal, paracrine, and neurocrine messengers (Schubert & Peura, 2008). The production of gastric acid undergoes three phases namely cephalic phase, gastric phase, and intestinal phase. Gastrin, the major hormonal trigger of gastric acid production is produced by the G cells located in the pyloric mucosa of the stomach. The G cells will release gastrin in response to a meal. However, the Histamine 2 receptors are thought to be the primary stimulus for the secretion of gastric acid.

How GERD, PUD, and gastritis affect the stimulation and production of gastric acid

Gastroesophageal reflux disease (GERD) is a common digestive disorder caused by reflux of acid in the stomach. GERD is more commonly referred to as a heartburn. Hydrochloric acid is naturally produced in the human stomach, which signals the gastric gland to secret gastric acid, which contains the essential digestive enzymes for breaking down protein molecules to enable easy digestion (Kahrilas, 2003). There are instances when too much or too little acid is produced. Too much secretion of the acid in the stomach causes an acid reflux to the esophagus, which results in a heartburn. This condition leads to an increase in the stimulation and production of gastric acid in the stomach. Gastric acid is a trigger to the symptoms of GERD. Offering dietary and lifestyle changes can reduce the amount of gastric acid produced in the stomach.

PUD (Peptic Ulcer Disease) refers to the painful sores in the lining of the stomach, or the duodenum. This mainly occurs due to the disturbance of mucosal integrity in the stomach, caused by local inflammation, which eventually leads to a mucosal defect. Based on the pathophysiology, the disease can be either acute or chronic. The pathophysiology would include those caused by anti-inflammatory drugs, excess acid secretion or transferrable etiology ulcers. There is a likely chance of a person suffering from PUD when they experience a massive secretion of gastric acid. Increased secretion of gastric acid mostly occurs to people who have increased parietal cells.

Gastritis is the inflammation of the stomach’s protective lining. Acute gastritis involves sudden severe inflammation, and chronic gastritis includes long-term inflammation that lasts for years if untreated. Gastritis is commonly caused by weaknesses in the stomach lining that allows digestive juices to inflame and damage it. There would be an increase in the production of gastric acid in the stomach of a person suffering from gastritis because their stomach wall would allow the acid to pass easily. Abnormal increase in the gastric secretion of the person would result in abdominal pain that would be caused by increased collision in the stomach.

How age affects the pathophysiology of GERD, PUD, and gastritis

It has been noted through various research that GERD in infants and children is more common than earlier thought, but it is more prevalent amongst the elderly. The elderly may suffer from abnormal reflux of acid into the esophagus. Elderly people have weakened muscles, thus are more prone to GERD, which would mean they suffer from more heartburns than the average adult does or their disease is more severe (Chait, 2010). A decrease in esophageal pain perception is demonstrated in elderly patients, thus making it seem they suffer less from GERD. Elderly people will have an increase in gastric acid production, which results in increase of GERD. The production of gastric acid would no longer be triggered by having a meal. The acid reflux would increase the amount of acid in the stomach and esophagus in elderly patients, because they would also have damaged the lining of the esophagus.

PUD on the other hand is most likely to affect people above 50 years. However, research has indicated that a majority of people about 70% of the population aged between 25 to 65 years suffer from the disease. Therefore, age is not a major contributor towards the pathophysiology of the disease, but older people are more likely to suffer from the disease. Anti-inflammatory drugs can result in the imbalance and lead to a massive secretion of gastric acid. This would result in PUD. Elderly people are mostly on anti-inflammatory drugs and one of the drugs can result in the condition.

The destruction of the stomach lining results in gastritis. Elderly persons are more likely to have their stomach lining destroyed and this would cause gastritis. As one ages, their stomach lining wall becomes weak and this makes it easy for acid to pass through the wall. An increase in gastric acid in the stomach would result in gastritis. An increase in acid production within the stomach would increase the destruction of the stomach lining, resulting in chronic gastritis.

Diagnosing and prescribing treatment for GERD, PUD, and gastritis

For GERD, there are three main tests used when a patient is suspected to have GERD. They are endoscopy, manometry, and esophageal pH monitoring. If GERD is detected by any of the tests, the goal of treatment would be to manage the disease (Boeckxstaens & Rohof, 2014). Reducing the amount of acid found in the stomach would be the main goal of treatment, which would also result in the decrease of reflux that occurs. Over the counter antacids can be prescribed for mild GERD and recommending lifestyle changes. A patient suspected of suffering from PUD would be required to undergo testing for h pylori infection (Konturek & Konturek, 2014). The best treatment for ulcers is identifying what causes them and recommending the patient makes lifestyle changes. A patient can also be given medication or undergo surgery. To diagnose gastritis, a physical evaluation would be performed, and a review of family and personal medical history. Tests would include blood test, upper endoscopy, or a stool test. Treatment would involve providing antacids in order to reduce stomach acid. Making changes in diet like avoiding spicy food, or dairy products.

Conclusion

The stimulation and production of gastric acid within the stomach aids in the digestion of food, but too much gastric acid would result in abnormalities. This abnormalities can result in different complications like GERD, PUD, or gastritis. The conditions are not life threatening and can be easily managed. However, they do affect the quality of life because they case the patient discomfort and pain.

References

Boeckxstaens, G. E., & Rohof, W. O. (2014). Pathophysiology of gastroesophageal reflux disease. Gastroenterology Clinics of North America, 43(1), 15-25.

Chait, M. M. (2010). Gastroesophageal reflux disease: Important considerations for the older patients. World journal of gastrointestinal endoscopy, 2(12), 388.

Kahrilas, P. J. (2003). GERD pathogenesis, pathophysiology, and clinical manifestations. Cleveland Clinic journal of medicine, 70(5), S4.

Konturek, P. C., & Konturek, S. J. (2014). Peptic Ulcer Disease Metabolism of Human Diseases (pp. 129-135). New York: Springer.

Schubert, M. L., & Peura, D. A. (2008). Control of gastric acid secretion in health and disease. Gastroenterology, 134(7), 1842-1860.


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