Abdominal: Gastro-oesophageal Reflux Disease Flashcards
What is GORD?
Gastro-oesophageal reflux disease
- Chronic relapsing condition
- Stomach contents rises into oesophagus
What can cause GORD?
- hiatal hernia
- impaired oesophageal clearance
- delayed gastric emptying
- impaired mucosal defensive factors
What risk factors are associated with GORD?
- stress/anxiety
- drugs (Anti-inflammatories e.g. ibuprofen)
- fat, chocolate, coffee
- alcohol
- large meals
- smoking
- hiatus hernia
What advice would you give to a patient if they have GORD?
- eat smaller/more frequent meals
- raise head end of bed
- lose weight if over weight
- find ways to relax
What would you advise against if a patient has GORD?
- avoid food/drink that triggers symptoms
- don’t eat before bed
- don’t wear clothes tight around chest
- don’t smoke
- don’t drink too much alcohol
- don’t stop taking prescribed medicine without talking to a doctor first
How does GORD present?
- heartburn
- regurgitation of food/acid
- patient complains of pain when drinking hot liquids or alcohol
- bad breath
- hoarse throat
- bloating/belching/hiccuping
what is dyspepsia?
a group of symptoms that alert doctors to consider disease of the upper GI tract including:
- upper abdominal pain or discomfort, heartburn, gastric reflux, nausea, or vomiting.
what conditions present in a similar way to GORD?
- Hiatus hernia
- Cardiac Ischaemic pain
what investigations do you use to diagnose GORD?
Diagnosis can be made without investigation.
If needed:
- endoscopy
- intraluminal monitoring (pH of oesophagus)
when should you refer a patient with suspected GORD for an endoscopy?
If GORD presented with GI bleeding.
what intervention should be made for uninvestigated dyspepsia?
- 2 week of PPI
- test for H pylori
What over the counter medication can be used for GORD?
Alginate-containing antacids (10 mL three times daily)
what do antacids do?
- over-the-counter medication for GORD
- form a gel or ‘foam raft’ with gastric contents to reduce reflux
side effects of antacids?
Magnesium-containing antacids tend to cause diarrhoea.
Aluminium-containing compounds may cause constipation.
If antacids fail to treat GORD what else can be purchased over the counter?
H2-receptor antagonists
(e.g. cimetidine, ranitidine, famotidine and nizatidine) are frequently used for acid suppression
What medication would you prescribe to treat GORD?
Proton pump inhibitors (PPIs)
omeprazole, rabeprazole, lansoprazole, pantoprazole, esomeprazole
What do Proton pump inhibitors (PPIs) do?
inhibit gastric hydrogen/potassium-ATPase
PPIs reduce gastric acid secretion by up to 90%
What intervention should be made for GORD?
- manage investigated ‘reflux like’ symptoms as uninvestigated dyspepsia
- offer PPI
- discuss how patient can manage their own symptoms
What surgery can be offered for GORD?
Laparoscopic Fundoplication
When should you consider a Laparoscopic Fundoplication for a GORD patient?
- confirmed diagnosis, adequate symptom control but do not wish to continue medication long term
- confirmed diagnosis, adequate symptom control but cannot tolerate acid suppression therapy
what complications can arise due to GORD?
peptic stricture
Barrett’s Oesophagus
Ulcers
What other healthcare professionals might be involved in a GORD patients care?
- nutritionist: control new diet/weightloss
- alcohol support group
- smoking cessation group
