Gastro-oesophageal reflux disease

Question 1

What is the definition of Gastro-oesophageal reflux

Answer 1

Physiologic reflux of gastric contents into the oesophagus not associated with retching or emesis

Question 2

What is the definition of gastro-oesophageal reflux disease

Answer 2

Excessive GER exceeding epithelial defences and eliciting symptoms such as heartburn or histopathologic injury

Question 3

What is the definition of laryngopharyngeal reflux

Answer 3

Reflux of gastric contents into the laryngopharynx

Question 4

What are the risk factors for GORD

Answer 4

Hiatal hernia
Obesity
Advanced age
Alcohol
Tobacco use
Ale sex
Obstructive sleep apnoea
Gastroparesis

Question 5

What is the Spectrum of GORD

Answer 5

Erosive reflux disease
Non-erosive reflux disease
Hypersensitivity oesophagus

Question 6

What are the 3 components that the normal antireflux mechanism is composed of

Answer 6

Mechanically effective LOS
Efficient oesphageal clearance
Adequately functioning gastric reservoir

Question 7

What are the characteristics that qualify a defective LOS

Answer 7

LOS with mean resting pressure of <6mmHg
Overall sphincter length of <2cm
Intrabdominal sphincter length of <1cm

Question 8

Explain the Los Angeles classification of oesophagitis

Answer 8

LA Grade A: Erosions limited to mucosal fold <5mm in extent
LA Grade B: Erosions limited to mucosal folds >5mm
LA Grade C: Erosions extending over mucosal folds but over less than 3/4 of circumference
LA Grade D: Confluent erosions extending more than 3/4 of the circumference

Question 9

What are the complications of GORD

Answer 9

Barrets oesophagus
- Columnar metaplasia of the oesophagus
- Peptic stricture formation
- Associated with adenocarcinoma

Question 10

What ar ethe extra-oesophageal complications of GORD

Answer 10

Chronic laryngitis
Adult onset asthma
Idiopathic pulmonary fibrosis
Chronic dry cough
Associated: Post-nasal drip, throath clearing

Question 11

What are the investigations to confirm GORD

Answer 11

Endoscopy - check for complications and malignancy
Barium swallow - Assess strictures, rings, hernia
24hr ambulatory pH monitoring

Question 12

Explain the management of a patient with GORD

Answer 12

Lifestyle modification:
- Elevate head of bed
- Avoid tight fitting clothing
- Eat small frequent meals

Medical therapy:
- Initially mild symptoms: 12weeks of PPI
- Patients with persistent syndrome: PPI lifelong

Surgery:
- If medical therapy failure
- Younger patient unwilling to take lifelong medication
- Structurally defective LES
- Development of complications
- Stricture
- Barrets oesophagus