Gastro-Oesophageal Reflux Disease Flashcards
Why does GORD occur?
exposure of acid and bile in the lower oesophagus
Risk Factors
Obese smoker alcoholic male pregnant on medication to lower LOS pressure hypomotility
What are the causes of GORD when there is no abnormal aetiology
delayed oesophageal or gastric emptying decreased acid clearance from the oesophagus decreased tissue resistance to acid increased transient relaxations of LOS LOS hypomotility
What does a burnt oesophagus lead to
Sphincter malfunction leading to hiatus hernia
Types of Hiatus Hernia
Type 1 = sliding
Type 2 = para-oesophageal
Pathophysiology
due to increased exposure of acid and bile, there is increased cell loss and inflammation which leads to erosive oesophagitis
Complications
Ulceration
Stricture Formation
Barrett’s Oesophagus
Carcinoma
What is Barrett’s Oesophagus
an abnormal change (metaplasia) in the cells of the distal oesophagus
How do the cells change in BO
from stratified squamous epithelium to simple columnar epithelium with goblet cells (seen in lower GIT)
What does BO predispose to
oesophageal adenocarcinoma as is a premalignant condition
Treatment of BO (high grade dysplasia)
Endoscopic Mucosal Resection
Radio-Frequency Ablation
Oesophagectomy (rarely)
Symptoms of GORD
Heartburn with cough and waterbrash
Sleep disturbance
Pharmacological Treatment of GORD
Alginates (gaviscon)
H2RA (histamine 2 receptor antagonist)
Proton Pump Inhibitor
Treatment of Refractory GORD
Fundoplication - wrapping fundus around the oesophagus to strengthen the sphincter and reduce acid reflux
