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 antibiotic¹⁸. 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 patient²¹. 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.

REFERENCES

1. Badillo Raul, Francis Dawn. Diagnosis and treatment of gastroesophageal reflux

disease. World j Gastrointest Pharmacol Ther. 2014. 5(3): 105-112. [ cited 2020 Dec
18 ]. Available from : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4133436/
2. Ndraha Suzanna, Oktavius Donny. Faktor-Faktor yang Berhubungan
dengan Keberhasilan Terapi GERD. J. Kedokt Meditek. 2016. Volume 22. P.8. [cited
2020 Dec 18]. Available from :
http://ejournal.ukrida.ac.id/ojs/index.php/Meditek/article/view/1447
3. Laitupa Afrita A., Nusi Iswan A. Pathogenesis, diagnosis and treatment of GERD
patients with asthma as extra esophageal manifestations. Faculty of Medicine
University of Muhammadiyah Surabaya. 2020. Vol 11. Issue 6. P.992 [ cited 2020 Dec
18 ]. Available from : https://www.sysrevpharm.org/fulltext/196-1594625824.pdf
4. Ajjah B. F. F., Mamfaluti T., Putra T. R. I. Hubungan Pola Makan Dengan Terjadinya
Gastroesophageal Reflux Disease. Journal Of Nutrition College. 2020. Vol 9. No.3.
P.169-179. [ cited 2020 Dec 19 ]. Available from :
file:///C:/Users/PC/Documents/GERD%20[prevalensi%20makalah].pdf
5. Heidelbaugh Joe J. Gastroesophageal Reflux Disease (GERD). Michigan Medicine
University Of Michi gan. (2018) [cited 2020 dec 2015]. Available from
https://www.med.umich.edu/1info/FHP/practiceguides/gerd/gerd.12.pdf
6. Tarigan R., Pratomo B. Analisis Faktor Resiko Gastroesofageal Refluks di RSUD
Saiful Anwar Malang. Jurnal Penyakit Dalam Indonesia. 2019 [ cited 2020 Dec 15 ] ;
Vol 6, No 2. Available from:
http://jurnalpenyakitdalam.ui.ac.id/index.php/jpdi/article/view/306
7. Hachem C., Clarrett Danisa M. Gastroesophageal Reflux Disease (GERD). The Journal
of the Missouri State Medical Association. (2018) [cited 2020 dec 2015] ; 115(3); 214-
218. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140167/
8. Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle Intervention in
Gastroesophageal Reflux Disease. Clinical Gastroenterology and Hepatology
[Internet]. 2016 Feb [cited 2020 Dec 17];14(2):175-182.e3. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636482/
9. Widiyanto J., Khaironi M. Hubungan Antara Tingkat Stres Dengan Kejadian Gastritis
(Study di Puskesmas Harapan Raya Pekanbaru). Jurnal Photon. 2014 [cited 2020 Dec
15];5(1).Available from:
https://www.researchgate.net/publication/339932033_HUBUNGAN_ANTARA_TIN
GKAT_STRES_DENGAN_KEJADIAN_GASTRITIS
10. Darmila A. Hubungan Karakteristik Pasien Asma Bronkial Dengan Gejala Penyakit
Refluks Gastroesofagus (PRGE) di RSUD dr. Soedarso Pontianak. Jurnal Mahasiswa
PSPD FK Universitas Tanjungpura. [cited 2020 Dec 17]. Available from:
https://jurnal.untan.ac.id/index.php/jfk/article/view/2821/2838
11. Sutawardana JH, Yulia, Waluyo A. Studi Fenomenologi Pengalaman Penyandang
Diabetes Melitus Yang Pernah Mengalami Episode Hipoglikemia. (2016) [cited 2020
Dec 16];1(1). Available from: https://repository.unej.ac.id/handle/123456789/77286
12. Yüksel, F., Doğan, M., Karataş, D., Yüce, S., Şentürk, M., & Külahli, I. (2013).
Gastroesophageal reflux disease in children with chronic otitis media with effusion. The
Journal of craniofacial surgery, 24(2), 380–383.
https://doi.org/10.1097/SCS.0b013e31827feb08
13. Wiranita HA. 2010. Hubungan Antara Oitis Media Supuratif Kronis Dengan Terjadinya
Vertigo Di RSUD dr. Moewardi Surakarta. Sebelas Maret Institutional Repository.
https://eprints.uns.ac.id/3459/
14. Mullin J, Gabello M,Murray LJ,Farrell CP,Bellows J,Wolov KR, et al. Proton
pump inhibitors: Actions and reactions. Drug Discovery Today :2009 [ cited 2020 Dec
17]Available from: https://sci-
hub.se/https://www.sciencedirect.com/science/article/abs/pii/S1359644609001159?vi
a%3Dihub
15. Gustarini, Indah Asmara., Kristyono, Irwan. 2016. Evaluasi Fiberoptic Endoscopic
Examination of Swallowwing Pasien Disfagia (Penelitian Retrospektif). Jurnal THT -
KL 9(3): 84 [cited 2020 Dec 16]. Available from:
http://journal.unair.ac.id/THTKL@assessment-of-fiberoptic-endoscopic-examination-
of-swallowing-on-dysphagia-patients-(a-retrospective-research)-article-12095-media-
43-category-.html
16. Pandaleke, Jenny J. C., Sengkey, Lidwina S., Angliadi, Engeline. 2014. Rehabilitasi
Medik pada Penderita Disfagia. Fakultas Kedokteran Universitas Sam Ratulangi
Manado. Jurnal Biomedik 6(3): 161 [cited 2020 Dec 16]. Available from:
https://ejournal.unsrat.ac.id/index.php/biomedik/article/view/6321/0
17. McCARTER D, URSULLA C, and M. POLLART S. 2007. Cerumen Impaction.
Journal American Family Physician 75(10) : 1524-1525 [ cited 2020 Dec 16]. Available
from : https://www.aafp.org/afp/2007/0515/afp20070515p1523.pdf
18. FaridaY, dan Oktaria D. 2016. Tatalaksana Terkini Otitis Media Supuratif
Kronis (OMSK). Jurnal Medula Unila 6(1) : 182 [ cited 2020 Dec 16] Available
from : http://repository.lppm.unila.ac.id/2303/1/Yusi-dan-Dwita-_-Tatalaksana-
Terkini-Otitis-Media-Supuratif-Kronis-OMSK.pdf
19. Yale JF, Begg I, Gerstein H, Houlder R, Jones H, Maheux P, et al. 2001. Canadian
diabetes association clinica; practice guidlines for the prevention and management of
hypoglycemia in diabetes. Canadian Journal of Diabetes 27(1) : 32-35 [ cited 2020 Dec
19]. Available from : https://guidelines.diabetes.ca/cpg/chapter14
20. Tarigan R., Pratomo B. Analisis Faktor Resiko Gastroesofageal Refluks di RSUD
Saiful Anwar Malang. Jurnal Penyakit Dalam Indonesia. 2019 [ cited 2020 Dec 15 ] ;
Vol 6, No 2. Available from:
http://jurnalpenyakitdalam.ui.ac.id/index.php/jpdi/article/view/306
21. McDonald-Haile J, Bradley LA, Bailey MA, Schan CA, Richter JE. 1994. Relaxation
training reduces symptom reports and acid exposure in patients with gastroesophageal
reflux disease. Gastroenterology. Journal Gastoenterology 107(1):61-9. [ cited 2020
Dec 18] Available from : https://pubmed.ncbi.nlm.nih.gov/8020690/
22. Sandhu,D dan Fass R. 2018. Stress and Gasthroesophageal Reflux Disease. Journal
Works of NTSh Medical Sciences 54(2) : 14 [ cited 2020 Dec 18 ] Available from :
https://www.researchgate.net/publication/331750691_STRESS_AND_GASTROESO
PHAGEAL_REFLUX_DISEASE