M.R. has smoked one pack of cigarettes a day for the past 35 years, drinks two or three beers on mostnights, and has noticed a 20-pound weight gain over the past 10 years. He feels "so tired and old now."M.R
has dark circles under his eyes and complains of constant daytime fatigue. His wife is even sleeping in
another bedroom because he is snoring so loudly. He also reinjured his lower back a month ago at work,
lifting a pile of boards, so his physician prescribed ibuprofen (Motrin) 800 mg bid or tid for 4 weeks.
Which factors in M.R.'s life are likely contributing to his chest pain and nausea?
Explain how.
• Smoking increases gastric acidity.
• Daily alcohol irritates the gastric mucosa; empty calories tend to replace healthy foods.
• Obesity slows gastric emptying, increases risk of sleep apnea, and represents poor dietary and
exercise habits.
• ASA (aspirin) and NSAIDs (ibuprofen [Motrin, Advil], naproxen [Aleve, Naprosyn]) block the
production of prostaglandins, which decrease the production of the protective mucous coating
that lines the gastric mucosa and acts as a buffer against the hydrochloric acid. Hydrochloric acid
is produced by proton pumps in the stomach and has a caustic pH of 2.0 . The cells that line the
esophagus don't produce the protective buffer and thus are at risk for injury when gastric acid
refluxes on it.
• Obstructive sleep apnea occurs when soft tissue of the oropharynx occludes the airway, triggering
pauses in respirations and resulting in hypoxia. The snoring sound represents the body's efforts
to pull O2 quickly into the lungs. The forceful inhalation pushes open the occluding soft tissue,
producing the snoring sound. The esophageal tube is right next to the trachea and has the
same surface opening. Thus the forceful inhalation often "sucks" the gastric juices up into the
esophagus, even over the vocal cords, into the lungs, or washing over the teeth, causing decay.
Given this information, symptoms of esophageal reflux disease include dysphonia, pharyngitis,
cough, new-onset asthma or sinusitis, odynophagia or dysphagia, a sensation of globus (that
something [i.e., phlegm] is stuck in the throat).
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