To Right The Wrongs: Reparations For Slavery Writing Sample

The question of reparations is by no means new, but a new impetus to the discussion of this topic was given by the activation of the Black Lives Matter movement. All of the Democratic presidential candidates in the upcoming US presidential elections have addressed this issue in their speeches. Several organizations have publicly apologized for their involvement in this shameful page of the past. However, activists believe that this is not enough, and raise the issue of reparations. This paper analyzes the articles and videos on reparations and discusses the practicability of this issue.

According to the BBC article “Should Black Americans Get Slavery Reparations?”, these claims are based on the idea that not only the victims themselves but also their descendants have the right to compensation for the harm. This article has a brief history and timeline of slavery and discusses the cases for and against reparations (“Should Black Americans Get Slavery Reparations?”). On the one hand, reparations aim to end inequality between white and black populations. If black lives are really important, slogans and symbolic gestures do not work, but the government must pay the debt. On the other hand, the possibility of such reparations can worsen relations between the representatives of different races.

Robert Johnson also considers that the US government must make reparations for slavery to address racial inequality. As understood from the CNBC Television video “BET Founder Calls for $14 Trillion of Reparations for Slavery,” the founder of RLJ Companies believes that slavery has given rise to a legacy of racial harm (CNBC Television). It continues to affect the living conditions of blacks in the United States. He has pointed to the higher number of homeless, unemployed, and convicted people among African Americans (CNBC Television). His main argument is that the effects of slavery are still felt in the form of economic and educational inequalities that need to be eliminated.

The issue of paying reparations to the descendants of slaves in the United States has caused heated debate in Congress. According to the article “Reparations Proposal Called a ‘Sham’ by Black Activists,” the presidential candidates’ position is ambiguous. Some potential Democratic candidates support reparations; however, Project 21 member Donna Jackson states that reparations for every African American is economically impractical (“Reparations Proposal Called a ‘Sham’ by Black Activists”). Reparations would be offensive to many black Americans, and they will only further split the country and make it harder to build the political coalitions needed to address the problems facing black people today.

The video “The Opinion Talk Show: Should Blacks Get Reparations for Slavery?” confirms the idea that what some people did to others 200 years ago has nothing to do with modern people. Moreover, it would be unfair to take money from today’s taxpayers for reparations for the misconduct of a small group of Americans who lived in the distant past (Santiago). Therefore, Moise Koffi says that discrimination is aside, and society as a whole is likely not to accept the arguments for reparations, considering issues related to slavery a part of history.

The issue of reparations for slavery has ceased to be only a theoretical topic for discussion by essayists, economists, and historians. It has become a key topic in the 2020 US elections and a part of the political course of the US Democratic Party. The main candidates in the presidential race support the idea itself and the H.R.40 bill associated with it (“Reparations Proposal Called a ‘Sham’ by Black Activists”). However, those who negatively react to the idea of reparations usually understand the scale of this financial burden. While it is unfair to extend the sins of fathers to their descendants, and this argument is certainly valid, there is more to this negative backlash in the discussion of reparations for black Americans.

The question is not whether modern white people are descended from oppressors and slave owners. The question is even not whether they are somehow directly responsible for paying for the crimes of their ancestors. The reality is that the nation has been using a certain group of people for slave labor for several hundred years, and then deprived them of their rights for another hundred years. It extended full civil rights to that population at the federal level only about 50 years ago. In the United States, the abolition of slavery was followed by a hundred years of inequality and segregation, especially in the south of the country. However, the discussion of making up for this abuse and exploitation is openly ridiculed.

The former colonial powers must repair the damage caused by centuries of violence and discrimination. The total number of victims of the slave trade is difficult to estimate, but not demanding the return of this money from the United States means not respecting the sacrifices made by the black ancestors. The state bears most of the blame because it created an environment in which individuals, organizations, and companies could participate in slavery and colonialism. Therefore, even if the direct distribution of money to the descendants of the blacks is not envisaged, various areas must be financed, and jobs must be created. Reparations should mean funding the health and education system, increasing affordable housing, and creating new jobs for black people.

Works Cited

CNBC Television. “BET Founder Calls for $14 Trillion of Reparations for Slavery.” YouTube, 2020, Web.

“Reparations Proposal Called a ‘Sham’ by Black Activists.” American Renaissance, 2019, Web.

Santiago, Mirna M. “The Opinion Talk Show: Should Blacks Get Reparations for Slavery?” YouTube, 2013, Web.

“Should Black Americans Get Slavery Reparations?” BBC News, 2019, Web.

Reducing Adverse Drug Events Among Older Adults

Organization Profile

The organization under analysis is Eisenhower Health Center.

Eisenhower Health Center is an acute care facility in southern California. It is a progressive 463-bed hospital. Its mission is to serve the changing healthcare needs of the region by providing excellence in patient care with supportive education and research (Eisenhower Health, n.d.).

The organization was rated with five stars by the Medicare website, which is a sign of the quality of care provided by the healthcare facility. Eisenhower Health Center has a culture of constant improvement, which makes it an excellent target for implementing a change program.

Problem Statement

In the hospital setting, one of the major concerns for healthcare managers is pharmaceutical products management and distribution. According to recent studies, one of the leading causes of severe complications is adverse drug events (ADEs) due to unaccounted drug-to-drug interactions (Toivo et al., 2016). ADEs are most frequent among older adults due to polypharmacy (Earl et al, 2020). Thus, the central purpose of my capstone project will be to create an initiative that will decrease the number of ADEs among older adults.

Proposed Solution

There are different approaches to reducing ADEs among older adults. They include the introduction of protocols and algorithms that support the decision-making process, direct education to patients, and medication reviews by pharmacists or clinicians. I propose a dual approach to the problem by introducing a clinical decision support system and provision of direct education to patients about ADEs. The solution of the problem was inspired by the national action plan for adverse drug event prevention published by the US Department of Health and Human Services (HHS, 2014). The policy recommends that education programs should concern anticoagulants, diabetic agents, and opioids, strict guidelines should be adopted to promote safe medication use, and organizations should monitor adherence to the guidelines. Thus, the action plan will be based on these recommendations.

Draft of Evidence

ECLIPSE Question

Asking the right question is crucial for acquiring support for clinical practice. Thus, the principles of evidence-based practice require that the clinical question is formulated precisely to ensure that evidence can be translated into practice. There are three mnemonics that are usually used for formulating clinical questions, including PICO (population, intervention, comparison, outcome), ECLIPSE (expectations, client groups, location, impact, profession, service), and PECOT (population, exposure, comparator, outcome, time period) (International Center for Allied Health Evidence, 2016). The proposed project will use the ECLIPSE mnemonic to ensure that the question includes all the vital elements of a well-built question.

The problem I am trying to address in my capstone project is adverse drug events (ADE) among older adults. Thus, the primary expectation (E) of the program is a decreased number of ADEs. The client group (C) is older adults, and the location (L) is the Eisenhower Health Center, as I used the healthcare facility for my previous projects. The impact (I) of the program will be similar to the expectation, as the success will be measured in the number of ADEs. The profession (P) is the front-line personnel, including nurses and physicians. The service (SE) under analysis is the provision of patient education about the prevention of ADEs. Thus, the ECLIPSE question is:

Will patient education about the prevention of ADEs provided by nurses and physicians decrease the number of ADEs among older adults in the Eisenhower Health Center?

Evidence

Medline and Cochrane databases were used to acquire evidence. The utilized keywords included adverse drug events, prevention, patient education, reporting. Even though the search generated more than 2000 results, the majority of studies were excluded as they did not relate to the topic of interest.

The results of the literature revealed that ADEs is a topic of increased interest among scholars and care providers. However, currently, patient education is not a popular method for reducing morbidity from ADEs. Medication review was the most common intervention to address the problem of ADEs (Tecklenborg et al., 2020). At the same time, the literature review revealed that education intervention is associated with decreased morbidity from ADEs (Ducoffe et al., 2016; Joshi et al., 2015; Khalil & Huang, 2020; Pagotto et al., 2013; Tecklenborg et al., 2020). In particular, patient education increases timely ADE reporting, which decreases morbidity and mortality (Ducoffe et al., 2016; Joshi et al., 2015 Pagotto et al., 2013). Additionally, it was found that patient education of older adults can decrease the occurrence of adverse drug events and the chances of opioid overdose (Tecklenborg et al., 2020; Khalil & Huang, 2020). Patient education was found to work well with other interventions, including drug reviews.

Implementation Plan

Goals and Timeline

There are at least three goals that can be identified for the project. First, the project aims at increasing the awareness among care providers about adverse drug events. Second, the project will improve the ability of frontline medical personnel to provide patient education concerning ADEs. Finally, the central goal of the program is to decrease the number of ADEs among older adults. Achievement of these three goals is expected to decrease morbidity and mortality from adverse drug events among older adults.

The project is expected to take almost six months. The implementation of the project will be based on the Diffusion of Innovation (DOI) theory. In 1962, E. M. Rogers identified five types of people, depending on their readiness to adopt change (Lien & Jiang, 2017). According to the theory, there are innovators (2.5%), early adaptors (13.5%), early majority (34%), late majority (34%), and laggards (Lien & Jiang, 2017). The theory includes three major steps, which are awareness, initial use, and prolonged use (Lien & Jiang, 2017). Base on DOI, the proposed timeline is the following:

  1. January 4, 2021: Program start
  2. January 4, 2021 – January 31, 2021: The dissemination stage
  3. February 1, 2021- February 28, 2021: Needs assessment and intervention planning
  4. March 1, 2021 – May 31, 2021: Provision of ADE education
  5. June 1, 2021 – June 14, 2021: Assessment of results. Consideration for further use
  6. June 15, 2021: Project End

Financials

The initiative is expected to have a significant financial impact. In particular, it will require some resources for providing education to care providers and increasing awareness about the necessity of change. The initiative will not require significant financial investments, as it is an educational project. However, there is some expenditure the Eisenhower Health Center will need to cover. First, every front-line employee will be required to finish a two-hour training course about how to provide patient education about adverse drug events. This will be associated with around $8,000 in cost associated with hiring a certified trainer and losing some productive hours of the personnel. Second, the facility will need to cover the expenses associated with the dissemination stage. During this stage, Eisenhower Health will conduct meetings, make posters, and email information concerning the problems with adverse drug events. This implies the meeting rooms and equipment for presentations will be needed. The overall cost is expected to be around $2,000. Finally, the facility will need to pay for the extra working hours of the change leader. They are estimated at $5,000 in total.

While the initiative is associated with several costs, it can bring some financial benefits. Currently, the cost of every adverse drug event is at least $2,000, including prolonged hospital stay and decreased reimbursements (Bhat & Udupa, 2016). Reduction in ADEs will lead to several changes, that can be converted into cash. First, decreased number of ADEs will decrease the average hospital stay. This will allow the hospital to serve more patients with the same resources. This will lead to increased revenues. Second, ADEs are often considered as the fault of the organization, which leads to reimbursement problems. Thus, the initiative will decrease the amount of bad debt by reducing the number of non-reimbursed services.

Finally, decreased number of ADEs will lead to improved quality of provided care, which will improve the facility’s reputation. This can also be converted to financial benefits.

Legal and Ethical Considerations

The initiative is not expected to experience any significant ethical or legal issues. However, there are two points that should be noted during the implementation. First, the program should be congruent with the National action plan for adverse drug event prevention developed by the US Department of Health and Human Services (2014). Additionally, patient education should be provided only if the patient agrees,

Measuring the Success

Goals and Milestones

The goal of the project is to decrease the number of ADEs among older adult patients. The goals are expected to be achieved by achieving the following objectives:

  • Disseminate information about the impact of ADEs;
  • Develop a patient education program about ADEs for older adults;
  • Provide training for frontline personnel;
  • Implement the new patient education program;
  • Evaluate the program.

The project is expected to have the following milestones:

  • January 4, 2020: Project Start; Dissemination phase starts.
  • February 1, 2020: Needs assessment and intervention planning phase starts.
  • March 1, 2020: The implementation phase starts.
  • June 1, 2020: The evaluation phase starts.
  • June 15, 2020: Project close.

Measures of Progress

The success will be measured using two variables.

The first variable will be the prevalence of ADE cases among older adults in percent. The variable will be measured using a pre-test post-test methodology. After receiving the results, statistical analysis will be used to understand if the change was significant.

The second variable will be the approval of first-line personnel. There is a high probability that statistical analysis will not detect the change, as the timeframe is rather small. Thus, an additional variable may be needed to assess the effectiveness of the intervention. This variable will be measured by asking the front-line personnel if they believe that the program was beneficial. If 80% or more agree that the intervention is beneficial for older adults, it will be considered a success.

Information

Four types of information will be gathered to measure the success of the program. First, the prevalence of ADE among older adults will be measured using electronic health records (EHRs). The data will be collected automatically using the hospital database. Second, adherence to the initiative will be measured by asking patients if they received education about ADEs. Third, employee approval will be measured by asking the front-line personnel if they believe that the intervention is beneficial for the target population. The assessment will be conducted using Google Forms. This survey will be one of the measures of success. Finally, patient satisfaction will also be measured by conducting surveys to see if provided education affected it.

Communication Plan

Audience

Before articulating the communication plan, it is crucial to understand the audience. The audience of the present communication plan includes different groups of stakeholders.

First, the project will be steered by the project management team. The primary interest of the management team is to implement the change with maximum efficiency, which implies that there is a low chance of resistance from these stakeholders.

Second, the project will need to be approved by the board of directors. This stakeholder provides the money for implementation with the primary aim to receive returns on investments. The interest of the stakeholder is to improve the efficiency and quality of provided services. Thus, medium resistance is expected due to the possibility of distrust with methods.

Third, care providers are the central stakeholders as they will need to implement the change. Their primary interest is personal growth and receiving money for their services. Since they will not be paid for providing patient education, they are likely to be the source of resistance.

Finally, trainers are another crucial group of stakeholders who will deliver training to the care providers. Since they will be paid for their service, there is a small chance that they will be a source of resistance.

Progress Communication

Even though the project requires the participation of multiple stakeholders, the communication plan is expected to be rather simple due to the straightforwardness of the action plan. There are expected to be three aspects of communication. First, there will be only two live meetings, at the beginning, and at the end of the project. All the major stakeholders will be invited to these meetings, including the board of directors of Eisenhower Health, the project management team, and front-line personnel. Formal progress report meetings will be held every first Wednesday of the month, where the project manager will provide a comprehensive assessment of the project. The meeting will be held in Zoom, where everyone will be provided with a formal document designed to outline the current state of the initiative. Apart from meetings, all the stakeholders will be able to communicate at any time via messages in a WhatsApp chatroom that will be created with all the stakeholders.

Change Management Plan

The desired change can be successful only if closely managed throughout the implementation. The change management plan for the initiative will include four stages. During Phase 1, the desire for change will be aroused in all the stakeholders. This will be achieved by conducting an assessment of the current situation about ADEs in Eisenhower Health and explaining the findings to the stakeholders. The need for change is usually aroused using effective communication, including meetings, posters, and motivating emails. All of these will be used in the first stage of the change management plan.

During Phase 2, the change plan will be created using the ideas of all the stakeholders. The plan will include detailed information about training schedules and ongoing assessments.

Phase 3 is the implementation of change, which implies that it is a very active change. During this stage, the change will be tailored using ongoing assessments and on-demand coaching.

The final stage will include assessments of the results to evaluate if the change was successful. During this stage, a decision will be made if the change was beneficial, and if the practice should be continued.

Post-implementation Communication

Post-implementation communication will consist of two aspects. First, all the stakeholders will be provided with a final report. This is a formal summative document that will include the analysis of results, including changes in the occurrence of ADEs, adherence to the new practice, and expected financial benefits. The report will also provide recommendations about if the new practice of providing patient education about ADEs to older adults should be continued.

The second aspect of post-implementation communication is the final meeting of stakeholders. During this meeting, the stakeholders will ask questions about the final reports and decide if the project was successful and the new practice should be continued.

References

Ducoffe, A. R., York, A., Hu, D. J., Perfetto, D., & Kerns, R. D. (2016). National action plan for adverse drug event prevention: recommendations for safer outpatient opioid use. Pain medicine, 17(12), 2291-2304.

Earl, T. R., Katapodis, N. D., & Schneiderman, S. R. (2020). Reducing adverse drug events in older adults. In Making healthcare safer III: A critical analysis of existing and emerging patient safety practices [Internet]. Agency for Healthcare Research and Quality (US).

Eisenhower Health. (n.d.). About us. Web.

International Center for Allied Health Evidence. (2016). Elements of a well-built question. Web.

Joshi, A., Shah, N., Mistry, M., & Gor, A. (2015). Evaluation of knowledge and perception toward adverse drug reactions among patients visiting tertiary-care teaching hospital. National Journal of Physiology, Pharmacy and Pharmacology, 5(4), 280.

Khalil, H., & Huang, C. (2020). Adverse drug reactions in primary care: a scoping review. BMC Health Services Research, 20(1), 5.

Pagotto, C., Varallo, F., & Mastroianni, P. (2013). Impact of educational interventions on adverse drug events reporting. International journal of technology assessment in health care, 29(4), 410.

Tecklenborg, S., Byrne, C., Cahir, C., Brown, L., & Bennett, K. (2020). Interventions to reduce adverse drug event-related outcomes in older adults: A systematic review and meta-analysis. Drugs & Aging, 37, 91–98

Toivo, T., Mikkola, J., Laine, K., & Airaksinen, M. (2016). Identifying high risk medications causing potential drug–drug interactions in outpatients: A prescription database study based on an online surveillance system. Research in Social and Administrative Pharmacy,12(4), 559-568.

US Department of Health and Human Services. (2014). National action plan for adverse drug event prevention. Health.gov. Web.

Gastroesophageal Reflux Disease

Description of Pathology

Gastroesophageal reflux disease (GERD) is a medical condition characterized by a frequent flow of stomach acid back into the esophagus. The backwash is known as acid reflux or acid indigestion irritates the lining of the esophagus and can cause a number of physiological issues as well as general discomfort. While everyone experiences acid reflux periodically, GERD is identified at mild stages at least twice a week (Mayo Clinic, n.d.). During an episode of GERD, an individual may taste food and stomach acid at the back of the throat causing discomfort. One of the most recognizable symptoms of GERD is regular heartburn, resulting in a burning, painful sensation in the chest. Other symptoms that adults may experience include respiratory problems, vomiting, bad breath, and nausea (NIDDK, 2020).

While the condition is not critical, over time GERD may cause serious complications including esophagitis which is the inflammation of the esophagus and a risk for precancerous changes. An esophageal stricture is also possible, narrowing the esophagus, causing issues with swallowing. GERD may cause breathing stomach acid into the lungs leading to respiratory problems such as asthma or recurring pneumonia (Mayo Clinic, n.d.).

Overall, GERD is a prevalent condition, affecting approximately 20% of adults in Western countries on a mild basis, with a third of that population having damage to the esophagus (NIDDK, 2020). GERD is a condition which must be studied and understood by medical professionals due to its prevalence and hidden risks, and a detailed analysis of its pathophysiology will be presented in this report.

Normal Anatomy of the Major Body System Affected

The esophagus is a muscular tube which connects the pharynx to the stomach, acting as a channel for transporting food and is also meant to prevent reflux of gastroduodenal contents. It extends 18-26 cm within the posterior mediastinum to the lower esophageal sphincter (LES). The esophageal wall is different morphologically from the rest of the gastrointestinal tract because it has no serosa and consists of mucosa and other elements. The muscles are arranged into an inner circular and outer layers. The muscle portions are connected by the vagus nerve which controls peristalsis depending on physiologic conditions (Menesez & Herbella, 2017).

The anti-reflux barrier is a sophisticated anatomical structure which creates a high-pressure zone via a synergy between the lower esophageal sphincter (LES) and a crural diaphragm. The function of the barrier is supported by the structure of the gastroesophageal flap valve consisting of the pharyngoesophageal ligament and gastric sling fibers of the gastric cardia. These elements position the intrinsic LES within the extrinsic crural diaphragm so that they overlap and create an effective barrier. The LES consists of a short tonically contracted muscle at the distal end of the esophagus. The resting tone for healthy people ranges from 10 to 30 mmHG. Typically, this creates a strong barrier to offset gastroesophageal pressure gradient across the esophagogastric junction (EGJ) (Tack & Pandolfino, 2018).

Normal Physiology of the Major Body System Affected

The upper esophageal sphincter (UES), the LES, and the esophagus function in a coordinated manner to allow for swallowing. When food is ingested, the UES is opened and then closed, propelling the item through the esophageal body and the relaxed LES into the stomach, and the LES then closes to prevent movement back into the esophagus. There is a mechanical effect of peristalsis which cleans the esophagus, and a secondary peristalsis occurs without swallowing.

At rest, the UES and LES are tonically contracted. Contraction of LES is the function of the muscle, not neural intervention. Therefore, when inhibitory fibers are stimulated in response to secondary peristalsis, transient LES relaxation occurs (tLESR) for 10-60 seconds spontaneously, relaxsing the LES and crural diaphragm. tLESR is a vagally mediated reflex which is normal and is triggered by gastric distention (Menesez & Herbella, 2017).

Reflux occurs through 4 mechanisms: transient lower esophageal sphincter relations (tLESRs), low LES pressure, swallow associated LES relaxation, and straining periods with low LES pressure. Prevention mechanisms against reflux vary due to the physiologic circumstances and anatomy of the EGJ. As an example, the crural diagphragm controls increases in intra-abdominal pressure and straining, while basal LES pressure helps manage reflux during resutful recumbency. Larger fluctuations exceeding 80 mmHG may occur. LES pressure is affected by myogenic and neurogenic factors impacting intra-abdominal pressure such as gastric distention, hormones, food, and medications (Tack & Pandolfino, 2018).

Mechanism of Pathophysiology

The pathological mechanisms of GERD are a reflection of imbalance between symptom-eliciting factors and defensive mechanisms. Extent of symptoms and mucosal injury is dependent on frequency of reflux events, and duration of mucosal acidification. GERD develops when the reflux of noxious gastric juice occurs into the esophagus. Excessive reflux exposure is prevented via the function of an anti-reflux barrier which is impaired in the condition.

If any of the 4 protective mechanisms described in the normal physiology are compromised, the harmful effects are increased along with number of reflux events and abnormal esophageal reflux exposure. The most common cause is LES dysfunction which occurs via mechanisms of transient relaxation, permanent relaxation, or a transient increase of intra-abdominal pressure which overwhelms the LES pressure capabilities.

In the context of diminished LES pressure, GERD occurs through strain-induced or free reflux. Strain-induced reflux results to a hypotensive LES being released due to abrupt increase in intra-abdominal pressure. This rarely occurs with LES pressure >10 mmHg or in patients without hiatus hernia. Meanwhile, free reflux is identified by a decrease in intra-esophageal Ph without change in pressure (Tack & Pandolfino, 2018).

The most frequent mechanism of tLESRs occurs during normal period of LES pressure, therefore independent of swallowing. tLESRs are characterized by diaphragmatic inhibition and persist for longer than typical LES relaxations during swallowing. The stimulus for tLESRs is a distention of the proximal stomach which stimulates the intraganglionic lamellar found at receptor ends of vagal afferents. The process is a complex mechanism of neurotransmitters and receptors which result in integrated motor response involve LES relaxation through reflex inhibitory actions and longitudinal muscle contraction which reduces EGJ obstruction and LES positioning, ultimately causing the GERD reflux (Tack & Pandolfino, 2018).

Delayed gastric emptying is another mechanism which leads to GERD. The delay leads to an increase in gastric contents which created added intragastric pressure that eventually collides with the LES. The LES is unable to withhold the pressure, resulting in acid reflux. Hiatal hernia is often mentioned in the context of GERD mechanisms, as it is a frequently encountered element in patients with symptomatic reflux but not a necessity. In hiatal hernia, the LES can migrate into the chest and lose the abdominal high-pressure zone. Furthermore, the diaphragmatic hiatus is potentially widened by a large hernia, disabling the crura function. Furthermore, gastric juice may be trapped in the hernial sac, and lead to reflux once the LES is relaxed (Tack & Pandolfino, 2018).

Prevention

Some of the underlying causes and risk factors of GERD come from lifestyle factors. Obesity is one of the primary due to excess belly fat which creates pressure on the stomach as well as the possibility of developing a hiatal hernia. Hormonal changes associated with obesity is also associated with GERD. Therefore, one of the primary prevention strategies is to maintain a healthy weight. Smoking is a causal factor as well since nicotine causes LES to relax unnecessarily. Eliminating smoking is a prevention strategy as well. For most individuals, changing food consumption habits is helpful to prevent mild GERD by eating smaller and more frequent meals, avoiding high fat or fried foods, and avoiding meals before bedtime or lying down (Mayo Clinic, n.d.).

Treatment

Most practitioners will recommend implementing lifestyle and dietary changes described above in cases of mild GERD. However, there are also treatments through medication, endoscopic therapy, and surgery. Medications such as antacids and histamine blockers which decrease acid levels and prokinetic agents which increase motility in the upper gastrointestinal tract are common prescriptions.

Transoral incisionless fundoplication (TIF or endoscopic therapy is a less invasive measure to a surgery and consists of using an endoscope to repair or recreate the valve which is the natural barrier to reflux. Finally, if none of the above work, surgery is an alternative which allows to strengthen the anti-reflux barrier through a procedure known as a Nissen fundoplication, providing permanent relief from reflux (John Hopkins Medicine, n.d.).

Conclusion

GERD is a common condition characterized by the release of acid reflux into the esophagus. This causes damage to the tissue and a number of side effects such as heartburn. An analysis of the anatomy and physiology shows that there is a natural barrier in the form of LES and crural diaphragm which are meant to prevent acid reflux. However, in a number of physiologic circumstances, the barriers are overwhelmed resulting in GERD. The condition is not serious and can be prevented and treated by lifestyle changes in most cases. However, pharmacological and surgical options exist which can regulate the acid reflux levels in the gastrointestinal tract.

References

John Hopkins Medicine. (n.d.). Gastroesophageal reflux disease (GERD) treatment. Web.

Mayo Clinic. (n.d.). Gastroesophageal reflux disease (GERD). Web.

Menezes, M. A., & Herbella, F. A. M. (2017). Pathophysiology of gastroesophageal reflux disease. World Journal of Surgery, 41, 1666-1671. Web.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2020). Acid reflux (GER & GERD) in adults. Web.

Tack, J., & Pandolfino, J. E. (2018). Pathophysiology of gastroesophageal reflux disease. Gastroenterology, 154(2), 277–288. Web.

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