Gastro-oesophageal Reflux Disease Flashcards
What is GORD due to?
Acid from the stomach refluxes through the LOS and irritates the lining of the oesophagus
How does GORD present?
Acid Regurgitation
Bloating, Water Brash
Cough (nocturnal)
Dyspepsia (heartburn)
How does dyspepsia present?
Retrosternal chest pain
Worse when lying down or after eating
What are the main causes of GORD?
Hiatus hernia
Smoking
Obesity
H. Pylori
How is GORD diagnosed?
Urea breath test
Endoscopy
What is a urea breath test used to test for?
H. Pylori
What would cause an incorrect result on a urea breath test?
Taking PPI’s 2 weeks before
When would you carry out an endoscopy for GORD?
If:
- Dysphasia (difficulty swallowing)
- Over 55 with ALARM symptoms
What are the ALARM symptoms?
Weight loss Dysphasia Nausea/Vomiting Over 55 Treatment resistant dyspepsia Low haemoglobin/ raised platelets
What is the main complication of GORD?
Barrett’s oesophagus
What is Barrett’s oesophagus?
Pre-malignant change for Adenocarcinoma
LO epithelium changes from squamous to columnar (metaplasia)
What is the lifestyle management of GORD?
Weight loss
Stop smoking
Reduce tea, coffee and alcohol
Small, light meals
What is the medical management of GORD?
Ant-acid
PPI
Alginates
What ant-acid would be given for GORD?
Magnesium trisilicate
Which Alginate would be given for GORD?
Gaviscon
Which PPI would be given for GORD?
Omeprazole
Lansoprazole
What is the surgical management of GORD?
Laparoscopic fundoplication
What are other complications of GORD?
Ulceration
Strictures
Oesophagitis
Iron deficiency
What is GORD due to?
Defective LOS
What is the initial management of GORD if endoscopically proven oesophagitis?
Full dose proton pump inhibitor (PPI) for 1-2 months
How is the treatment changed after full dose PPI for 1-2 months if there is a response?
if response then low dose treatment as required
What is the management if there is no response to 1-2 months of full dose PPI?
if no response then double-dose PPI for 1 month
What is the Endoscopically negative reflux disease?
full dose PPI for 1 month
What is the management of endoscopic negative refleux disease if no response to PPI?
if no response then H2RA or prokinetic for one month
What is an example of a H2RA drug?
Ranitidine
