Gastro-Oesophageal Reflux Disease Flashcards
What is the normal resting pressure of the LOS?
10-15mM above the pressure inside the stomach
What things can happen if the mechanisms that protect the oesophagus from reflux fail?
Transient LOS relaxations Hiatus hernia Low oesophageal sphincter pressure Impaired oesophageal clearance Increased intra-abdominal pressure Reduced gastric emptying
What is a hiatus hernia?
Protrusion of part of the stomach through diaphragmatic hiatus into the chest.
- sliding - just the GOJ protrusion
- rolling - entire fundus protrusion
What is Barrett’s oesophagus?
When acid reflux from the stomach causes the epithelium in the oesophagus to change from non-keratinised stratifies squamous epithelium into simple columnar
What is the best test used to test for GORD?
Endoscopy- direct visualisation, so you can tell is it’s a tumour or acid reflux. Also allows for biopsy at the same time
Name some type of drugs used to treat high acid levels in the stomach.
Antacids - decreases pepsin activity (so pH can increase)
Mucosal agents
H2 receptors antagonists
Prokinetics - increase LOS pressure
PPI inhibitors
Alginates - forms a foamy barrier over the stomach juice
What is the surgical option for treatment of GORD?
Nissan fundoplication
- the fundus of the stomach is wrapped round to LOS, to increase tone
- can’t relax, so patients can’t vomit, and causes bloating
What are the symptoms of GORD?
Heartburn Regurgitation Epigastric pain Nausea Non-cardiac chest pain Wheezing
How can pH monitoring be performed?
A catheter is inserted through the nose and dangles down the oesophagus until 5cm above the LOS
This can detect any acid reflux by measuring the pH at this level
What are the normal mechanisms of controlling acid reflux?
Intrinsic sphincter - thickened layer of circular muscle
Extrinsic sphincter - diaphragm
Angle of His - acute angle created by the cardia at the entrance to the stomach, forming a valve
Secondary peristalsis - clears acid from lower oesophagus
