0205 - Reflux and GORD

Question 1

What are the three causes of LOS-modulated reflux?

Answer 1

Low pressure/incompetent sphincter
Transient sphincter relaxation
Increased intra-abdominal pressure (e.g. pregnancy)

Question 2

What are the 5 broad causes of reflux?

Answer 2

Lower oesophageal sphincter issues
Diaphragmatic crura/fat pad
Hiaitus hernia
Motility problems
Drugs/hormones

Question 3

Outline the Los Angeles Classification of reflux oesophagitis

Answer 3

Time exposure correlates with severity.
LA Grade A - One or more mucosal breaks, less than 5mm long, not extending between tops of two mucosal folds.
LA Grade B - One or more mucosal breaks, more than 5mm long, not extending between tops of two mucosal folds.
LA Grade C - One or more mucosal breaks, continuous between the tops of two or more mucosal folds but involving less than 75% circumference.
LA Grade D - One or more mucosal breaks, involving at least 75% of circumference.

Question 4

What are GORD and NERD?

Answer 4

Gastro-Oesophageal Reflux Disease
Non-erosive reflux disease.
While GORD produces ulcers/erosions that can metastasise, NERD does not (though symptoms can be equally severe). Only about 10% of NERDs become GORDs.

Question 5

How is reflux diagnosed?

Answer 5

Symptoms - Two or more days/week, particularly if at night.
Endoscopy
Barium swallow if required
24hour pH study can be completed.

Question 6

Name two other conditions reflux is associated with

Answer 6

Laryngitis (OR 2.01)
Laryngeal stenosis (OR 2.10)

Question 7

Name four complications of reflux

Answer 7

Oesophagitis
Stricture
Barrett’s oesophagus
Oesophageal adenocarcinoma.

Question 8

What is Barrett’s Oesophagus?

Answer 8

Squamous epithelium in lower oesophagus replaced by metaplastic columnar. Significant dysplasia can occur, with a high malignant potential (0.2-0.5%/year), particularly in caucasian males over 50.
Can be either long or short (<3cm) segment, with BMI correlation, and particularly long segment is associated with hiatus hernia.

Question 9

How is Barrett’s Oesophagus scored?

Answer 9

Prague classification -
C=Circumfrential (maximum amount of metaplasm over circumference)
M = Maximal (maximal ‘height’ of metaplasm).

Question 10

What are the broad treatment options for Barrett’s Oesophagus?

Answer 10

Lifestyle modification - weight loss, elevate bed head.
Drugs - antacids, PPIs (also Histamine receptor antagonists, prokinetics)
Surgery - Fundoplication