Stressful psychosocial factors and the Gastro-esophageal Reflux Disease (GERD) are increasingly challenging societies in industrialized countries such as Norway and the United States. Gastro-esophageal Reflux Disease (GERD), also referred to as the acid reflux disease, is a chronic condition in which the stomach contents are pushed backwards into the esophagus damaging its inner lining. The damage happens because the stomach contents are acidic having been mixed with hydrochloric acid. Psychosocial stress is a disorder that is linked to the exacerbations of such symptoms as inflammation of the gastrointestinal tract. The disorder is common in both the United States and Norway. Upon being surveyed, sufferers with GERD symptoms have reported that they notice an increase of such symptoms as they advance in age (Levenson, 2010).
In the United States, studies have revealed that GERD affects between 25% – 40% of adult population, and the symptoms are noticeable in varying degrees. About 10% of adults experience GERD-related symptoms on weekly and, at times, on a daily basis. The prevalence of the condition is also increasing among children and infants. There are variations in the prevalence of GERD symptoms among individuals belonging to different ethnic groups in the American society (Granderath et al., 2006). Nevertheless, various studies have indicated comparable prevalence of GERD especially among African Americans and Caucasians while lower rates of symptoms have been noticed with individuals of Hispanic, North American, and Asian origin. In Norway, stressful psychosocial factors relating to job dissatisfaction have been found to have a twofold increased risk of GERD as compared to persons reporting to be satisfied with their jobs. Other types of pressures increase the prevalence of GERD symptoms, and this has specifically been noted in Norway. Pressures may emanate from anxiety, depression, angina pectoris, myocardial depression, stroke, and even insomnia. All these factors have significantly contributed to the increase of GERD among individuals living in the Norwegian society.
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Studies targeting the American and the Norwegian societies have indicated that the main psychosocial stressors in the countries are (Scott, 2009):
- chronic strain that relates to intimate relationships, work, friends, family, and health;
- episodic stressors of live events such as death or serious illness of a spouse, miscarriage, and divorce; and
- stress that afflicts the sufferer on a daily basis.
In both countries, patients with GERD symptoms often experience heartburn, which a pain behind the sternum or in the abdomen. The pain is, at times, accompanied by a sour taste in the sufferers’ throat. Furthermore, patients in both countries experience pain and difficulty while swallowing food, belching, and other serious challenges. Patients often visit a doctor when reflux persists, a situation which would take as much as three months (Granderath et al., 2006).
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Causes and Risk Factors
The causes and risk factors that are associated with the gastro-esophageal reflux in both Norway and the United States are comparable. Doctors in both countries associate GERD with a condition that is referred to as hiatal hernia which greatly weakens the LES besides causing reflux. Basically, hiatal hernia occurs when the upper abdominal section moves up into the chest via a small opening in diaphragm that is referred to as the diaphragmatic hiatus. The diaphragm has featured greatly in recent studies as it consists of an opening that serves as an additional sphincter. This sphincter is around the lower end of the esophagus (Granderath et al., 2006).
It has been found that hiatal hernia causes the retention of acid together with other contents that are above the opening. As such, the substances do reflux easily into the esophagus. The hiatal hernia can be caused by coughing, vomiting, straining, as well as sudden physical exertion as these actions result in the increased pressure in the abdomen (Rees, 1997). Hiatal hernia, which is a key contributor of GERD in the United States and Norway, is aggravated by obesity and pregnancy. The condition is most prevalent among the middle-aged individuals of both countries. It, however, does affect the individuals belonging in other age groups though mildly (Goroll & Mulley, 2009).
Other causes of GERD in Norway and the United States are associated with dietary and lifestyle choices. As such, certain food items and beverages, for instance, chocolate, fried fatty foods, peppermint, coffee, spicy and citrus foods, caffeine, and alcoholic beverages contribute greatly to the weakening of the LES. The weakening, in turn, causes reflux and heartburn. Additionally, poor eating habits such as eating in large quantities especially 2-3 hours before bedtime could increase the chances of acquiring GERD. Sufferers are advised to take small quantities of food but on frequent occasion, and this ought to be spread throughout the day. In Norway and the United States, the condition has been prevalent among people who often assume such poor postures as slouching as this hinders progression of food down the throat and towards the stomach (Goroll & Mulley, 2009).
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Symptoms of GERD
Both the United States and Norway have similar characteristics and it is for this reason that, for the two nations, the symptoms exhibited by those who suffer from GERD bears similarity. For instance, for the two societies the most common symptom is a persistent heartburn. Also called acid indigestion, heartburn is a burning sensation at the center of the chest behind the breastbone which often begins in the upper abdomen before spreading upwards into the chest. Often, it worsens after an individual has taken his/her meals. However, not every Norwegian or American who suffers from GERD ends up experiencing heartburn (Levenson, 2010). It is estimated that more than 60 million American adults suffer GERD and heartburn at least once in a month while about 25 million adults experience heartburn almost on a daily basis. While 25 percent of all pregnant women report to have experienced heartburn on a daily basis, over 50 percent of them argued that heartburns are occasioned by distress. Furthermore, those who suffer from GERD in America and Norway report to experience regurgitation of bitter acid up into the throat especially when sleeping or bending over. They also experience bitter taste in the mouth, persistent and dry coughing, and hoarse voices especially in the morning (Goroll & Mulley, 2009).
Dealing with Health Issues in both America and Norway
Every year, the United States spend millions for the purpose of dealing with GERD-related challenges as well as such psychosocial stressors as depression. Physicians in Norway and the United States utilize acid-suppressing drugs like proton pump inhibitors (PPIs) in the tackling the upper gastrointestinal problems (Goroll & Mulley, 2009). This has proved to be effective during the management of GERD. However, the challenge of tackling GERD and acidity problem has proved to be a too difficult challenge for any of the two countries to tackle. This is because GERD induces such complex clinical challenges and systematic symptoms as laryngeal and pulmonary problems, and these problem are difficult to revert (Goroll & Mulley, 2009).
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In the United States and Norway, about 2% of the population is under a long-term acid suppression therapy and since a significant portion of these are above 65 years of age, the situation is complicated (Richter, 2012). Also, it has become increasingly apparent that acid suppression, though highly effective for acid-related diseases, is futile in situations when, say, functional heartburn is associated with GERD (Goroll & Mulley, 2009).
It is evident that psychosocial factors and GERD are on the rise in America and Norway, and this is aggravated by the difficult economic times, environmental challenges, and the kind of lifestyle that individuals have adopted (Levenson, 2010). Job losses and an increasing rate of unemployment are some of the reasons that are proving really stressful for the citizens. For instance, people have begun neglecting their diet, and this increases the risk of acquiring GERD. In summary, governments need to step up the efforts of tackling the psychosocial stressors and the underlying causes of GERD by enhancing research as well as informing the public.