What is the primary clinical manifestation of greatest concern with a peptic ulcer?

Choice A reason:
Sucralfate does not primarily work by reducing acid production but rather by forming a protective barrier over ulcers. The statement "Sucralfate reduces acid production in the stomach" is incorrect. Sucralfate's main action is to adhere to the ulcer site and protect it, thus helping in the healing process. The student’s misunderstanding is that sucralfate reduces acid production, which is not the primary mechanism of action for this medication.

Choice B reason:
Sucralfate is known for having minimal systemic side effects because it works locally in the stomach rather than being absorbed into the bloodstream. The statement that sucralfate does not cause systemic side effects is correct, as sucralfate's action is mainly localized to the gastrointestinal tract, making systemic side effects uncommon.

Choice C reason:
Sucralfate should indeed be administered one hour before meals. This timing allows it to form a protective barrier on the stomach lining before food can stimulate acid production, which is crucial for its effectiveness in treating peptic ulcers. Therefore, the statement about its administration time is correct and does not indicate a need for further teaching.

Choice A reason:
Loss of muscle tone at the lower esophageal sphincter (LES) is the primary cause of GERD. The LES normally prevents stomach contents from refluxing into the esophagus. When its tone is reduced, acidic gastric contents can flow back, leading to symptoms such as heartburn, regurgitation, and potential damage to the esophageal lining. Factors contributing to LES dysfunction include obesity, hiatal hernia, and certain dietary habits.
Choice B reason:
Sympathetic nerve stimulation is not a cause of GERD. The autonomic nervous system plays a role in regulating digestive functions, but GERD is primarily a mechanical issue involving the LES and is not directly related to sympathetic nervous activity.
Choice C reason:
Fibrosis of the lower third of the esophagus is typically associated with conditions such as scleroderma, which can lead to esophageal motility disorders. While fibrosis might contribute to esophageal dysfunction, it is not the primary cause of GERD.
Choice D reason:
Reverse peristalsis of the stomach is not a mechanism for GERD. GERD results from dysfunction of the LES, not from the backward movement of stomach contents due to altered motility.