62. Gastro-oesophageal Reful Disease

Question 1

What are the symptoms of GORD?

Answer 1

Heartburn, 
belching, 
bile regurgitation, 
increased salivation (waterbrash), 
odynophagia (painful swallowing)

Extra oesophageal symptoms- nocturnal asthma, chronic cough, laryngitis, sinusitis

Question 2

What are the causes of GORD?

Answer 2

LOS hypotension
Hiatus hernia
Oesophageal dysmotility
Obesity 
Gastric acid hypersecretion
Delayed gastric emptying 
Sinusitis

Question 3

What are the complications of GORD?

Answer 3

Oesophagitis 
Ulcers, 
Benign strictures
Iron deficiency 
Metaplasia (Barrett’s oesophagus)

Question 4

What are the two types of haitus hernia?

Answer 4

Sliding- gastro-oeosphageal junction slides into chest. This causes reflux of contents as bolus are forced back.

Rolling- part of stomach moves up, but LOS stays in its place

Question 5

How is a haitus hernia investigated?

How is a haitus hernia treated?

Answer 5

Upper GI endoscopy

Lose weight
Treat GORD
Surgery only after aggressive medical therapy

Question 6

How is GORD investigated?

Answer 6

Upper GI endoscopy if dysphagia/ALARM symptoms

24 hour oesophageal pH monitoring +/- manometery

Question 7

How do you treat GORD with lifestyle changes?

Answer 7

Weight loss
Smoking cessation
Small regular meals
Reduce hot drinks/alcohol/citrus/fruits/tomatoes/onions/spice/caffeine

Question 8

How do you treat GORD with drugs?

Answer 8

Antacids-magnesium trisillicate
Alginates- gaviscon
H2 blockers- e.g. ranitidine

Question 9

How do you treat GORD with surgical management?

Answer 9

Laparoscopic Nissan fundoplication
Radio frequency induced hypertrophy of LOS

Consider in sergers GORD that doesn’t respond to drugs