1
Human Physiology Case Studies 2025/2026
Gastrointestinal Case History - Case 19 - correct answer>>A 26-year-old business
executive complained of a dull pain (heartburn) behind the sternum. The pain was
postprandial (occurred after meals) and disappeared within a few minutes to an
hour. It was often associated with belching and often was worse on lying down or
on exertion after heavy meals. Sometimes it radiated to the back, jaws, shoulders,
and down the inner aspects of the arms, simulating angina pectoris. X-rays
revealed a small portion of the stomach above the diaphragm, and an endoscopic
biopsy revealed mucosal inflammation. Esophageal manometry (determining
pressures at the lower esophageal sphincter, LES) revealed decreased LES
pressure. Esophageal pH monitoring showed reflux of gastric contents into the
esophagus and provided direct evidence of gastroesophageal reflux.
Recommended treatment for this individual is avoidance of strong stimulants of
gastric acid secretion (e.g., coffee, alcohol) and avoidance of certain drugs (e.g.,
anticholinergics), and specific foods (fats, chocolates, whole milk, and orange
juice), and smoking, all of which reduce LES competence. Elevation of the head of
the bed by about six inches is also recommended. Suggested treatments also
include the use of cholinergic agonists (e.g., bethanechol) and the use of
histamine (H2) antagonists (cimetidine).
What is the disorder of this 26-year-old business executive? - correct answer>>a
hiatal hernia, which is a structural defect in which a weakened diaphragm allows a
portion of the stomach to pass through the esophageal opening into the chest,
where pressure increases
What mechanisms normally prevent gastric reflux into the esophagus when lying
down or bending over? - correct answer>>adequate lower esophageal pressure at
the lower esophageal sphincter
Why are anticholinergic agents avoided and cholinergic agonists recommended in
the treatment of gastrointestinal reflux? - correct answer>>the PS division of the
