Patient Overview Case Study for MBBS Students GERD Management

Introduction

Mr. Ashfaque, a 58-year-old bank manager, presents to Dr. Salman, a gastroenterologist, with a feeling of something stuck in his throat, particularly after eating, and slight difficulty swallowing food. This case study explores the causes, symptoms, diagnosis, and management of GERD and Barrett’s esophagus, providing valuable insights for medical students.

Medical History

• Burning in Stomach and Sour Fluid in Throat: Experiences burning in stomach and sour fluid in throat with burping for the last two years.
• Throat Symptoms: Recent development of throat symptoms over the last few months.
• Lifestyle Factors: High-stress job with frequent fast food consumption and carbonated drinks. Fond of having coffee during working hours.
• Previous Treatment: Treated with antacids for one and a half months without improvement.

Clinical Examination

• Symptoms: Consistent with GERD as explained by Dr. Haider.

Investigations

• Endoscopy: No constriction or obstruction observed, redness near lower esophageal sphincter.
• Biopsy: No dysplasia, Barrett’s esophagus confirmed.

Differential Diagnosis

• GERD (Gastroesophageal reflux disease)
• Esophageal stricture
• Esophageal cancer
• Achalasia

Most Likely Diagnosis

GERD with Barrett’s esophagus, as confirmed by endoscopy and biopsy results.

Signs and Symptoms of GERD and Barrett’s Esophagus

• GERD:
  • Burning sensation in the stomach
  • Acid reflux
  • Burping
  • Feeling of something stuck in the throat
  • Difficulty swallowing
• Barrett’s Esophagus:
  • Persistent acid reflux
  • Chronic sore throat
  • Difficulty swallowing
  • Chest pain (less common)

Difference Between Metaplasia and Dysplasia

• Metaplasia: Reversible change in which one type of cell is replaced by another type, often as an adaptive response to chronic irritation.
• Dysplasia: Abnormal cells with changes in size, shape, and organization, which may be a precancerous condition.

Histological Differences Between Normal Esophagus and Barrett’s Esophagus

• Normal Esophagus: Stratified squamous epithelium, uniform cells without abnormal changes.
• Barrett’s Esophagus: Intestinal metaplasia with columnar epithelium replacing the squamous epithelium, presence of goblet cells.

Why Does Acid Reflux Cause Metaplastic Changes in Epithelium? How Does This Change Help in This Condition?

Acid reflux causes chronic irritation and inflammation of the esophageal lining, leading to metaplastic changes where the squamous epithelium is replaced by columnar epithelium with goblet cells, which is more resistant to acidic environments.

Changes in Diet and Lifestyle Suggestions for Patients

• Avoid fatty, spicy, and acidic foods.
• Reduce intake of carbonated drinks and coffee.
• Eat smaller, more frequent meals.
• Avoid eating close to bedtime.
• Elevate the head of the bed.
• Quit smoking and limit alcohol consumption.
• Maintain a healthy weight through diet and exercise.

Management and Treatment

• Medications:
  • Proton pump inhibitors (PPIs).
  • H2 receptor blockers.
  • Antacids.
• Lifestyle Modifications: As mentioned above.
• Regular Follow-ups: Repeat endoscopy/biopsy as advised.
• Monitoring for Complications: Such as dysplasia or esophageal cancer.

Potential Complications

• Esophageal stricture.
• Esophageal ulcer.
• Increased risk of esophageal adenocarcinoma.
• Chronic pain and discomfort.

Note for MBBS Students

A multidisciplinary approach involving gastroenterologists, dietitians, and potentially oncologists is crucial for optimal management and care.

Conclusion

This case highlights the importance of early diagnosis and intervention in managing GERD and preventing complications such as Barrett’s esophagus. Comprehensive management involving dietary and lifestyle changes, medications, and regular monitoring is essential for improving patient outcomes. Always consult a healthcare professional for personalized medical advice.

For more detailed information on GERD and Barrett’s esophagus, visit MSMBBs Blog.