Gastroesophageal Reflux Disease (GERD) Relates to Poor Quality of

Adult’s Life
Achmad Thariq Rizqullah,¹ Adinda Fazzahra Salma,¹ Andi Amanda Artenia Putri,¹
Annisa Anggie Tjahyaning Negri,¹ Cinta Widya Riamarni,¹ Dea Arshila,¹ Eleonora
Cathlin Kusuma,¹ Filzah Qori Isnaeni,¹ Marshanda Salwa,¹ Martinus Yudha,¹ Melza N.
Ramadhania,¹ Muh. Afdal R Tamani,¹ Mochamad Daffa Athallah,¹ Novelia Ayu
Widianti,¹ Tsabitha Salwanastiti,¹ Zalfa Alifia Rahmi,¹
¹Faculty of Dental Medicine, Universitas Airlangga
Surabaya – Indonesia

ABSTRACT
Background: Gastroesophageal Reflux Disease (GERD) is a chronic disease that
occurs in adults. The factors that can cause GERD are lifestyles including diet and poor
psychological condition. Purpose: To understand the relationship between a bad lifestyle
and the occurrence of Gastroesophageal Reflux Disease (GERD) in adults. Case(s): A 29-
year-old patient who has a busy schedule, procrastination habits and environmental pressure
cause his lifestyle to be bad. Poor lifestyle and irregular diet in adults can lead to stressful
conditions that affect the reflux of gastric acid which causes GERD. GERD experienced by
the patient can trigger few symptoms such as chest pain, swallowing difficulties, cold body
and heavy breathing. Case Management: Treatment management that can be done is taking
Proton Pump Inhibitor (PPI) drugs to treat chest pain and shortness of breath followed by
performing FEES to determine the cause of dysphagia, performing middle ear canal
irrigation and oral therapy in the form of amoxiclav antibiotics also doing relaxation
hypnosis and progressive muscle relaxation for stress management. Discussion: Poor
lifestyle and diet, especially in adults, can be a triggering factor for GERD because they are
related and can cause stress. Several medications can be done to reduce the symptoms
suffered by GERD. However, changes in lifestyle are critical factors in reducing the various
symptoms that arise due to GERD itself.

Keywords: GERD; Poor life quality; Adult

Correspondence:
Cinta Widya Riamarni
Faculty of Dental Medicine, Universitas Airlangga - Surabaya, Indonesia.
cintawidyawati@gmail.com
INTRODUCTION
Gastroesophageal reflux disease (GERD) known as symptoms or mucosal damage
produced by the abnormal reflux of gastric contents into the oesophagus or beyond, into the
oral cavity (including larynx) or lung¹. GERD is also known to be the reflux of stomach
contents into the oesophagus which can cause common symptoms such as heartburn (burning
in the epigastric area), acid regurgitation (bitter taste in the mouth) and dysphagia
(swallowing difficulties)². This disease is complex, chronic, and often causes recurrences³.
GERD prevalence in America is higher than Asia. Almost 7% of the population in
America has complaints about heartburn and 20%-40% is estimated to suffer from GERD ⁴.
According to National Ambulatory Medical Care Survey (NAMCS), it is estimated that 38,53
million outpatients visits by adults every year are associated to GERD⁵. Even though Asia
has fewer case numbers, there is still an increase in GERD prevalence in 2019 which
approximately 22,8% of them are esophagitis’ cases⁶.
The high prevalence of GERD is influenced by several factors such as older age,
excessive body mass index, smoking, anxiety or depression, and inadequate physical
activities. In addition, a poor diet can also be the cause of GERD starting from the acidity
of the food, size or portion, and meal times, especially those related to sleeping⁷. GERD is
also associated with decreased health related quality and adult’s productivity⁸.

CASE(S)
Busy schedule, procrastination habits, and environmental pressure can cause a poor
lifestyle on a 29-year-old patient. A poor lifestyle and irregular eating patterns in adults
impact stress conditions. Prolonged stress may increase gastric acid⁹. Untreated rise of
gastric acid may cause GERD. Stress conditions that occur in GERD patients cause shortness
of breath due to the rising of gastric acid from the stomach to the oesophagus. If the sphincter
is unable to sustain it, gastric acids may move from the stomach upwards. Those acids can be
sucked into the lungs and cause a restriction in the respiratory tract¹⁰.
Irregular eating habits can cause hypoglycaemia, a condition that occurs when the
body lacks sugar in the bloodstream. In general, this condition has physical symptoms that
are weakness, tremor of the extremities, tachycardia (fast heart rate) and palpitations
(irregular heartbeat). These are all caused by the release of epinephrine in the initial
mechanism of hypoglycemia¹¹.
 GERD which is experienced can cause several symptoms such as chest pain,
swallowing difficulties, cold, and heavy breathing (experienced along with stress). GERD
itself is identified as a complex disease since it can cause several new symptoms like otitis
media and vertigo. The reflux of gastric fluids into the Eustachian tube due to GERD
becomes a trigger for effusion in the middle ear¹². The spread of tympanic membrane
infection on otitis media patients can cause disturbances in body balance also known as
vertigo¹³. All untreated symptoms which occurred may lead to collapse.

CASE MANAGEMENT(S)
Proton Pump Inhibitor (PPI) is the treatment for patients experiencing shortness of
breath and chest pain. PPI class drug’s mechanism is to inhibit acid production at the final
stage of acid secretion, namely (H+, K+)-ATPase enzyme from the proton pump of the
parietal cell¹⁴. PH (gastric lumen) response to PPI use varies and depends on the route of
administration along with the dose and timing which is related to food. To evaluate an
accurate pH, an intragastric pH probe must be used to assess gastric efficacy or a 24-hour
intraoesophageal pH monitor that can be used to determine the effect of drugs in the
esophagus¹⁴.
One of the supporting examinations in dysphagia patients is Fiberoptic Endoscopic
Examination of Swallowing (FEES). Fiberoptic Endoscopic Examination of Swallowing
(FEES) is an examination of the pharyngeal phase of the swallowing process performed
endoscopically¹⁵. The endoscope is inserted through the nasopharynx and placed into the
laryngopharynx over the false vocal cords. Liquid and solid boluses are colored green so they
are easy to choose¹⁶. The FEES procedure assesses the anatomy and physiology of
swallowing, the airway and its relationship with swallowing function, diagnosis and
treatment plans¹⁵.
Case management for the treatment of otitis media patients is by performing irrigation
of the middle ear. Ear canal irrigation is a process of cleaning the wax that clogs inside the
ear. Irrigation can be done alone, or preceded with ceruminolytic therapy and also oral jet
irrigator method¹⁷. Irrigation fluids consist of 0,9% NaCl, H2O2 and acetic acid. Some
solution is drained through the external auditory canal using an irrigation syringe and allows
draining for 5-10 minutes before topical antibiotic¹ ⁸. Patients are also given oral therapy in
the form of 3 x 625 mg of amoxiclav antibiotics for five days. Amoxiclav is a β-lactam dan β-
lactamase inhibitor class drug that is sensitive to Pseudomonas aeruginosa and
Staphylococcus aureus, the most common bacteria found in otitis media patients¹⁸.
 Patients with a poor lifestyle and diet may easily suffer from hypoglycaemia.
Hypoglycaemia itself has several symptoms like cold body, tremor, and heart palpitation.
Treatment for hypoglycaemia patients can go through three modalities that are oral glucose,
intravenous glucose and intermuscular glucose¹⁹. Oral glucose is distributed to light-mild
hypoglycaemia with 20 grams of glucose in forms of jelly, candy, or fruit juice. Intravenous
glucose is given to patients who delayed oral glucose with the form of 75-100 ml glucose
20% or 150-200 ml glucose 10% followed by infusing another 5% of glucose. On the other
hand, intramuscular glucose is administered in a dose of 1 mg subcutaneously or
intramuscularly²⁰.
Apart from the things mentioned above, psychological factors play a role in the
perception of gastroesophageal reflux disease symptoms. It has long been known that the
oesophagus reacts to psychological stress and emotional states. An alternative and
investigative approach are required in patients with GERD. This approach can be done by
hypnotic relaxation induction that shows that it can produce a decrease in gastric acid
secretion. Relaxation effects caused by hypnosis can also be reached by using progressive
muscle relaxation. Progressive muscle relaxation procedure requires at least specific training
that produces a deeply relaxed state and arguably more acceptable by the patient ²¹. Pain in
GERD patients accompanied by acute stress has been proven through an increase in the
perceptual response to intraoesophageal acid²².

DISCUSSION
A poor lifestyle and diet, especially in adults, can be a triggering factor for GERD
because both are related to the patient’s mental and psychological condition. A poor lifestyle
may cause mental and psychological issues due to anxiety or depression and lack of physical
activities. This may affect a person’s quality of life and even lead to stress. If it is unbalanced
with a regular diet and a healthy lifestyle, stress may cause a disturbance in the digestive
system, one of which is the rising of gastric acid. A high concentration of gastric acid causes
the sphincter muscles on the stomach to weaken until it is unable to maintain the gastric acid.
As a result, there is a reflux of acids from the stomach to the oesophagus or known as GERD.
As explained before, GERD patients who experienced stress can be treated by giving
40 mg of esomeprazole for 8 weeks daily that can weaken the effect of acute stress on the
acid stimulus-response function. This treatment significantly decreases the oesophageal
perception of response to acid even during acute stress stimulation. In addition, stress
management may be performed by psychiatry visiting, hanging out with friends or family,
relaxing in the middle of a routine, taking a stroll, or listening to good music.
A poor lifestyle is associated with a poor diet which can cause hypoglycaemia due to
the lack of carbohydrates or delayed eating time. Hypoglycaemia occurs when blood sugar
levels in the body drastically decrease by less than 70 mg/dl. Some symptoms caused by
hypoglycaemia are cold and weak body, palpitations and tremor.
Treatments like FEES, endoscopy and ear canal irrigation are performed only to
reduce the symptoms caused by GERD. Treatment that has been applied is only prevention of
other contracting diseases that may be more severe than GERD itself. However, the most
important thing to do is to improve our lifestyle. Adjusting our diet is a fundamental method
since GERD is triggered due to an irregular diet. Another example is by maintaining body
cleanliness through daily routines such as taking a shower, brushing our teeth twice a day,
washing our hands before and after doing activities and also changing clothes after outdoor
activities. As a balancing factor, it is also necessary to maintain our sleep habits and exercise
regularly.

ACKNOWLEDGEMENT
We would like to thank Dr. Pratiwi Soesilawati, drg., M.Kes as our tutor for her
efforts and expertise in the creation of this scientific article. Your help enabled us to meet the
scheduled time and to maintain the standards of peer-reviewed journals. Your dedication is
most appreciated as the number of manuscripts is increasing every year.

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