GERD: Gastroesophageal Reflux Disease: Role of Saliva & Gastric Acid in Digestion & Erosive Disorders Affecting Tooth, Stomach, and Esophagus
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This student-centered, small-group activity supports goals set forth in Report IX, Contemporary issues in medicine: oral health education for medical and dental students. The exercise uses disorders of gastric acidity to (i) highlight oral-systemic connections in collaborative patient care, and also to (ii) impart requisite foundational knowledge and clinical reference that enable an understanding of the oral manifestations of systemic diseases and oral-systemic interactions. The target audience is any health professions student who seeks to attain those cross-cutting competencies that promote the common attitudes, knowledge, and skills necessary to prepare for effective practice and interprofessional collaboration in today’s health care environment. Imparting these competencies to students will contribute to the general aim of Building Oral Health Capacity (BOHC) in our health care delivery system.
GERD happens when a LES (lower esophageal sphincter) defect permits gastric acid reflux to the esophagus. The consequences and/or complications include: heartburn, cough (irritated throat, larynx, epiglottis), asthma (bronchial irritation), dental erosion, bad breath, bad tastes, and more serious, a precancerous condition known as Barrett’s Esophagus, and ultimately esophageal cancer. A careful oral examination, whether by physician or dentist, can provide the initial GERD diagnosis, which is key to preventing progressive illness. This exercise addresses key issues in the biochemistry, physiology, pharmacology, and management of gastric acidity. A clinical vignette, The Case of Gerdy Williams, unfolds along with these scientific issues.
This is a highly-constrained, student-centered, activity consisting of a take-home tutorial (instructional text, questions, detailed answers) on GERD and its scientific underpinnings plus a small-group activity in which instructors are to act as group facilitators—not purveyors of knowledge. The included student-resources (scientific content with clinical reference, study-questions, detailed answers) enable instructor-independent study at home. This “homework” prepares the student for small group activity. The instructor-resources (step-by-step session timeline, pre-written quizzes, answers, and listed learning issues) create conditions for productive, student-centered discussion that can be facilitated by non-expert faculty (group leaders). A novel 3-quiz paradigm, included in the session timeline, provides incentives for students to do each of three important things: (i) study at home so as to arrive prepared, (ii) share knowledge in the group discussion, and (iii) and profit from the discussion by actively engaging peers in thoughtful give and take.
The exercise self-assesses. Students who struggle on the 1st quiz tend to perform measurably much better on the 3rd quiz—a gratifying outcome for student and instructor alike. On average, it is found that (i) the group performs better than the individual, and (ii) individuals perform 20 percent better on Quiz 3 than on Quiz 1. Students who truly struggled on Quiz 1 often perform several hundred percent better on Quiz 3. Thus, the 3-Quiz paradigm not only identifies struggling students, but goes the extra mile by measurably improving their knowledge in the short-term. Long-term retention is encouraged by writing midterm examination questions that focus precisely on weaknesses identified by quizzing (although this use of the midterm exam is not formally part of the exercise).
This unique student-centered exercise (on GERD, gastroesophageal reflux disease) does two important things: (i) it minimizes the instructor's traditional role as a purveyor of knowledge, and (ii) it evaluates its own effectiveness each time it is used. The learning experience begins with a self-contained take-home assignment that includes (i) knowledge content, (ii) multiple-choice questions to focus and self-evaluate on key issues, and (iii) narrative explanation of each multiple-choice. Next, the students break into small groups (6-8 students, and participate in a novel 3-quiz paradigm that is designed to keep the student intellectually engaged during three separate phases in the learning process: (i) during self-study at home, (ii) during small group discussion, and (iii) during evaluation (quizzing). Quiz 1 discriminates against the cohort of students that profit little from the take-home assignment (encourages engagement at home). Quiz 2 is a group effort that allows students to help one another with difficult content, and helps struggling students come up to speed. Quiz 3 encourages active engagement in the discussion, and evaluates session effectiveness by demonstrating the extent to which students know more than they did on Quiz 1. TYPICAL OUTCOME: On average, students perform about 20 percent better on Quiz 3 compared to Quiz 1. Importantly, students who accomplished little at home often perform several hundred percent better on Quiz 3—an outcome that is gratifying to the student and instructor alike, the latter feeling that he has made a difference for students that ordinary assessments would have identified as deficient without taking steps to ameliorate the deficiency.
Currently, we are in the midst of a global GERD epidemic. In 2000-2001, a US Ambulatory Medical Care Survey found that 22 percent of primary care visits were related to GERD in some way. GERD prevalence stands at 25 percent on a rising trend of 4 percent per year between 1995 and 2005. Understanding disorders that affect gastric acidity (e.g., GERD) is very much a multi-disciplinary enterprise. This exercise explores an array of basic science issues that underpin disorders of gastric acidity and their clinical management.
King S. GERD: gastroesophageal reflux disease: role of saliva & gastric acid in digestion & erosive disorders affecting tooth, stomach, and esophagus. MedEdPORTAL Publications. 2012;8:9266. http://doi.org/10.15766/mep_2374-8265.9266
- To define what GERD is and contrast it to silent-GERD.
- To describe the reversible and irreversible oral manifestations of GERD.
- To describe the common purpose of tooth and acid in the digestive process.
- To explain how the parietal cell makes HCl, and how this process is regulated.
- To describe the specializations that make the stomach more acid-resistant than the esophagus and how compromise of these protections will lead to disease.
- To explain non-medical interventions that a patient can use to ameliorate GERD symptoms.
- To describe medical treatments and interventions that a physician can recommend or perform to ameliorate gastric acidity and GERD symptoms.
- GERD, Gastric Ulcer, Digestion, Stomach, Esophagus, Omeprazole, Bisphosphonate, Helicobacter Pylori, Tooth Decay, Gastric Acid, Building Oral Health Capacity (BOHC) Collection
This information is made available under the Creative Commons license.
Authors & Co-Authors
Steven C. King, PhD
Oregon Health & Science University School of Medicine
Sponsorship or Funding Source
This project is sponsored in part by funding from the Health Resources and Services Administration/Maternal Child Health Bureau grant #U44MC20223.