Compare and Contrast Table
GERD
GERD (Gastroesophageal Reflux
Disease) is characterized by mucosal
damage caused by stomach acid refluxing
into the lower esophagus.
PUD (Peptic Ulcer Disease)
Hydrochloric acid (HCl) and pepsin break down
the mucosa of the gastrointestinal tract, causing
PUD. Ulcers form in parts of the GI tract exposed
to gastric secretions. It is possible to categorize
PUD as gastric or duodenal, based on its location.
Causes
GERD is caused by frequent acid reflux
or reflux of nonacidic stomach contents. It
results from an incompetent lower
esophageal sphincter (LES), which allows
gastric contents to move into the
esophagus, especially when lying down or
with increased intra-abdominal pressure.
Helicobacter pylori (H. pylori) and long-term use
of
nonsteroidal
anti-inflammatory
drugs
(NSAIDs) are two of the most common causes of
peptic ulcers (Aleve).
Risk Factors
Obesity: Increases intra-abdominal
pressure.
In most cases (80-90%), Helicobacter pylori
cause peptic ulcers.
Smoking: Cigarettes and cigars can
worsen GERD.
Long-term use of nonsteroidal anti-inflammatory
drugs (NSAIDs) such as ibuprofen (e.g., Advil,
Motrin IB) can lead to ulcers.
Definition
Hiatal hernia: Affects LES function.
The lifestyle:
alcohol, chocolate, certain drugs, fatty
foods, nicotine, peppermint, tea, and
coffee (caffeine).
stress
Smoking
Alcohol and caffeine consumption
Bile reflux can contribute to gastric ulcers.
Age and Gender: Gastric ulcers are more
prevalent in women and those over 50 years of
age.

Pathophysiology GERD is a chronic gastrointestinal condition in
It occurs in an acidic environment when mucosal
which mucosa are damaged by acid and defense mechanisms are disrupted by aggressive
pepsin secretions from the stomach. The factors. Gastric mucosa is destroyed and inflamed
result is esophagitis in which the esophagus by HCl back diffusion, releasing histamine.
becomes inflamed and irritated. It is believed Vasodilation increased capillary permeability,
that an incompetent LES is the main cause of and secretion of acid and pepsin result from this
release.
the disease.


Symptoms
 The most common symptom is burning
under the sternum or tightness in the
throat or jaw.
 In older adults, chest pain can mimic
angina.
 An upper abdominal discomfort called
dyspepsia.
 In regurgitation, a hot, bitter, or sour
liquid rises to the mouth or throat.
 Dyspnea, wheezing, and coughing.
Once the cause of the ulcer is removed,
acute ulcers usually resolve quickly with
minimal inflammation.
Ulcers that penetrate the muscular wall
develop fibrous tissue. Patients may suffer
intermittent attacks for months or years.
Acute ulcers are rarer than chronic ulcers.
Gastric
• Discomfort generally high in epigastrium
&occurs 1-2 hours after meals.
 The pain is burning or gaseous
 If the ulcer has eroded through the gastric
mucosa, food tends to worsen the pain.
Duodenal
 Symptoms occur when gastric acid come in
contact w/ the ulcers
 with meal ingestion, food is present to help
buffer acid (food helps)
 Symptoms generally occur 2-5 hours after
meals and pain is burning or cramp like;
can also cause backpain
 Hoarseness, sore throat, lump in the
throat, hypersalivation, and choking are
Otolaryngology symptoms.
Some patients have bloating, nausea, vomiting, &
early feelings of fullness; dyspepsia
 Endoscopy: Assesses LES function,
inflammation, scarring, and strictures.
\ An endoscopy is the most accurate method of
detecting ulcers. During the procedure, tissue
specimens are taken to detect H. Pylori. Healing
is also assessed.
Labs
 Esophagram (barium swallow): Finds
problems with the upper GI tract.
 Distinguishes GERD from stomach or
esophageal cancer through biopsy and
cytology.
 H. pylori Testing:

Test for urease after antral mucosa biopsy.
 Examines esophageal and LES pressure
and motility.
 Detects reflux and esophageal
clearance rates with radionuclide tests.
o
Treatment
 Omeprazole, lansoprazole:



Reduce HCl acid production by
inhibiting proton pumps.
There's a risk of kidney disease,
vitamin B12 deficiency,
magnesium deficiency, and
dementia with long-term use.
The lowest effective dose should
be taken for the shortest amount of
time.
 Anti H2 blockers (e.g., ranitidine or
famotidine):


H2 receptors are blocked, so HCl
isn't secreted as much.
Reduce mucosal irritation in the
esophagus and stomach.
 Antacids:



HCl acid needs to be neutralized.
After meals and at bedtime.
Interacts with other medications.
 Prokinetic Agents (e.g.,
metoclopramide):


Gastric emptying is improved by
increasing LES pressure.
Patients with known delayed
gastric emptying should not use

Urea breath tests, stool antigen tests, and
serology.
 Other Lab Tests:




Blood count (CBC)
A liver enzyme study
Analyze serum amylase (for pancreatitis)
Blood in the stool
 Medications.





Proton pump inhibitors for H. Pylori.
Antacids and H2 receptor blockers reduce
gastric acid secretion.
Mucosal protection with cytoprotective
agents.
For 4-6 weeks, discontinue aspirin and
nonselective NSAIDs.
Adequate rest, Smoking cessation ,Dietary
modifications ,Long-term follow-up care
also help in eradicating H pylori infection.
 Nutritional Therapy:



Patients should consume foods and fluids
that do not exacerbate symptoms.
Pepper, carbonated beverages, broth,
spicy foods, and caffeine may cause GI
upset.
Symptoms can be worsened by alcohol as
it delays gastric emptying.

this product due to significant side
effects.
References:
Antunes, C. (2023, July 3). Gastroesophageal reflux disease. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK441938/
Do you have peptic ulcer disease?. Cleveland Clinic. (2024a, June 21).
https://my.clevelandclinic.org/health/diseases/10350-peptic-ulcer-disease