Gastric juices encompass the various digestive juices secreted by the stomach. The main role of gastric juices is to help in the breaking down of food during digestion and killing of any bacteria that gets into the stomach. The gastric parietal cells on the stomach walls are the main producers of gastric juices. According to Schubert & Peura (2008), the secretory canaliculus, the region in the lumen whereby gastric acids are secreted, is regarded as having the greatest acidic content in the entire body. Gastric acid is secreted in the lumen after the neurocrine inputs and paracrine hormonal glands receive various messages. The core gastric acid production hormonal stimulation is enabled by the production of gastrin. The stomach’s pyloric mucosa houses the G cells that produce the gastric juice. The parietal cells are stimulated by variety of inputs that allow them to have an ability to facilitate the secretion of hydrogen ions into the gastric lumen. However, the main gastric acid secretion stimulus is the Histamine 2 receptors. The G-Cells secrete gastrin following an intake of food by an individual, and this links to the cholecystokinin receptors located on the parietal and enterochomaffin-like cells. A discharge of the intracellular calcium and proton pump initiation occurs following the amalgamation poof the parietal cells and gastrin. Schubert & Peura (2008). The production of cyclic AMP is increased when ECLK cells and gastrin leads to the formation of histamine which bonds to Histamine-2 receptors. Similarly, at the canalicular membrane, there occurs the activation and translocation of the proton pump.
Changes that Occur to Gastric Acid Stimulation and Production with GERD, PUD, and Gastritis Disorders
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The stimulation and production of gastric acid are affected by various disorders such as Peptic Ulcer Disorders, Gastroesophageal Reflux Disease and Gastritis. Peptic Ulcer Disease is the stomach’s mucosal integrity disturbance. PUD results in the emergence of mucosal defects due to disturbances occurring in the stomach because of increased stimulation and production of gastric acid. On the other hand, gastritis disorder will bring about secretory glands erosion due to inflammation. In the long run, there is an absence of gastric glands in the stomach hence leading to a reduced stimulation and production of gastric acid. GERD refers to movement of injurious substances such as acids and pepsin into the oesophagus from the stomach. During the development of GERD disorder, there is an increased overproduction and stimulation of gastric acid by the glands. This leads to worsening of the GERD condition due to an increased volume of gastric acid into the esophagus resulting from a damaged lower esophageal organ.
Impact of Age on the Pathophysiology of GERD, PUD, and Gastritis
Gastrointestinal Tract Disorders in the elderly are very prevalent. However, this does not indicate that the elderly are the only ones suffering from GI disorders. The GI system changes that occur in the older adults are at times pathological and physiological, especially in people aged 65 years and above (Dumic et al., 2019). The continued decline of physiological integrity is the main distinctive feature of aging across all human beings. This brings about an elevated vulnerability to death and impaired functioning of various body organs. The deterioration in such functions has been linked to a substantial number of diseases affecting the elderly generation such as neurodegenerative disorders, cardiovascular disorders, diabetes, cancer and GI disorders. Through aging, the gastrointestinal system functions are largely affected, and these include absorption, digestion, hormonal and enzyme secretion and motility.
Nonetheless, no GI disease is limited to aging though some illnesses are more prevalent during this stage in life. The emergence of GERD is enabled once stomach contents being to bring about troublesome effects. According to Dumic et al. (2019), 23% of the elderly population suffers from GERD. The severity of GERD in the elderly is facilitated by an increased prevalence of hiatal hernia, odynophagia and dysphagia. The prevalence hiatal hernia is known to increase in with age, and this is found in over 60% of adults aged 60 years and above and up to 90% of those aged 70 years and above (Vaezi & Swoger, 2006).
PUD is mainly associated with the injury to the gastric glands and duodenal peptic glands. The main root of ulcers in the ageing population is increased use of aspirins/NSAIDs and H. pylori infection (Dumic et al., 2019). The incidence of PUD in older adults is very high as compared to the general population. The major cause of PUD in older adults is also the use of SSRIs, anticoagulants and polypharmacy. These bring about a reduced GI system blood flow and reduced secretion of essential components such as prostaglandins, mucin, and bicarbonates (Pilotto et al., 2010).
Gastritis disorders are highly prevalent in older adults. The pathophysiology of the disorders is mainly boosted due to the existence of H. pylori infection. The partial loss of gastric mucosa glands leads to hypochlorhydria or achlorhydria. According to a study by Kim et al. (2008) and Weck & Brenner (2006), 50% of adults aged 60 years and above in China and Japan suffer from gastrointestinal disorders.
Diagnosis and Treatment Prescription
The main treatment option used in GERD is the use of antacids to control the heartburns. However, in the older generation suffering from GERD, the use of antacids is associated with negative effects such as hypomagnesemia, hypercalcemia and constipation. Therefore, the primary treatment modality for this condition in the elderly is the use of H2-receptor antagonists and proton pump inhibitors (Firth & Prather, 2002). However, proton pump inhibitors are the most economical treatment modality as it does not bring about non-compliance nor affect the general and hepatic functions.
According to Khan & Howden (2018), proton pump, inhibitors have over the years shown a higher healing rate in the diagnosis and treatment of gastrointestinal tract disorders as compared to histamine-2 receptor antagonists. The elderly generation should, therefore, use PPIs, and they should undertake an 8-week PPI therapy course. The administration of PPIs should take place about one hour before taking any meals to ensure their effectiveness is maximized. Nonetheless, in case of a relapse of the gastrointestinal tract disorders, one should continue using PPIs. The use of PPIs in the elderly population is thus the best diagnostic and treatment option for those suffering from gastric disorders, GERD and PUD.
References
Dumic, I., Nordin, T., Jecmenica, M., Stojkovic Lalosevic, M., Milosavljevic, T., & Milovanovic, T. (2019). Gastrointestinal Tract Disorders in Older Age. Canadian Journal of Gastroenterology and Hepatology , 2019 .
Firth, M., & Prather, C. M. (2002). Gastrointestinal motility problems in the elderly patient. Gastroenterology , 122 (6), 1688-1700.
Khan, M. A., & Howden, C. W. (2018). The role of proton pump inhibitors in the management of upper gastrointestinal disorders. Gastroenterology & Hepatology , 14 (3), 169.
Kim, N., Park, Y. S., Cho, S. I., Lee, H. S., Choe, G., Kim, I. W., ... & Song, I. S. (2008). Prevalence and risk factors of atrophic gastritis and intestinal metaplasia in a Korean population without the significant gastroduodenal disease. Helicobacter , 13 (4), 245-255.
Schubert, M. L., & Peura, D. A. (2008). Control of gastric acid secretion in health and disease. Gastroenterology , 134 (7), 1842-1860.
Weck, M. N., & Brenner, H. (2006). Prevalence of chronic atrophic gastritis in different parts of the world. Cancer Epidemiology and Prevention Biomarkers , 15 (6), 1083-1094.
Vaezi, M. F., & Swoger, J. (2006). Gastroesophageal reflux disease in the elderly. In Gastroesophageal Reflux Disease . Springer, Vienna.
