Gastro-oesophageal reflux Flashcards
How common is it?
5 in 1000 person years
Who does it affect?
Potentially anyone.
What causes it?
Failure of the lower oesophageal sphincter (LOS) (transient lower oesophageal sphincter relaxations)
A large hiatus hernia interfering with the mechanism of the LOS and associated antireflux systems (flap valve of intra-abdominal oesophagus, gastric mucosal rosette and crural diaphragm contraction).
Barrett’s oesophagus
What risk factors are there?
Pregnancy Obesity Fat, chocolate, coffee or alcohol ingestion Cigarette smoking Drugs - antimuscarinic, calcium-channel blockers, nitrates Systemic sclerosis Hiatus hernia After treatment for achalasia
How does it present/what are the symptoms?
Heartburn/reflux pain - worse on bending, stooping or lying down. Seldom radiates to the arms, worse with hot drinks or alcohol, relieved by antacids.
NOT - gripping, crushing, radiating to neck/left arm, worse with exercise, accompanied by dyspnoea (cardiac)
What signs may the patient have on examination?
Usually nil
Which other conditions might present similarly?
Angina/myocardial infarction - 20% of cases admitted to coronary care have GORD
What are the red flag symptoms?
Weight loss Melaena Coffee ground emesis Difficulty swallowing Persistent vomiting Epigastric mass Fe-deficiency anaemia
How would you investigate this patient?
Not usually necessary
Endoscopy - mainly for ruling things out
How would you explain this condition to the patient?
Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet).
It usually occurs as a result of the ring of muscle at the bottom of the oesophagus becoming weakened. Read more about the causes of GORD.
GORD causes symptoms such as heartburn and an unpleasant taste in the back of the mouth. It may just be an occasional nuisance for some people, but for others it can be a severe, lifelong problem.
GORD can often be controlled with self-help measures and medication. Occasionally, surgery to correct the problem may be needed.
What treatments would you discuss with the patient?
Weight loss (if necessary) Raising the head of the bed at night Dietary measures Alginate-containing antacids Dopamine anatagonist prokinetic agents H2-receptor antagonists Proton pump inhibitors
In extremis:
Endoluminal gastroplication
Surgery
