GASTRO-OESOPHAGEAL REFLUX DISEASE Flashcards
WHAT IS GORD?
- weakness in LOS leads to gastric acid from stomach leaking into oesophagus, resulting in pain and damage to oesophagus
WHAT ARE THE RISK FACTORS FOR GORD?
1) age
2) obesity
3) male
4) alcohol
5) smoking
6) spicy/ fatty foods
7) hiatus hernia
WHAT ARE THE CLINICAL FEATURES OF GORD?
1) retrosternal chest pain - worse after meals, lying down, bending over
2) excessive belching
3) odynophagia
4) chronic cough
WHAT ARE THE RED FLAG SYMPTOMS FOR AN UPPER GI MALIGNANCY THAT YOU NEED TO BE AWARE OF?
- patients with dysphagia
- Any patient >55yrs with weight loss and upper abdominal pain, dyspepsia, or reflux
WHAT ARE THE DIFFERENTIAL DIAGNOSIS FOR GORD?
1) malignancy- oesophageal or gastric
2) peptic ulcer
3) oesophagitis
4) myocardial infarction
5) biliary colic
WHAT ARE THE COMPLICATIONS OF GORD?
1) Barrett’s oesophagus
2) Oesophagitis
3) Aspiration pneumonia
WHAT DO YOU DO IF YOU COME ACROSS THESE RED FLAG SYMPTOMS?
- urgent upper GI endoscopy
WHAT ARE THE INVESTIGATIONS FOR GORD?
1) PPI trial - 8 weeks to see symptomatic improvement
2) Endoscopy is dysphagia or >55yo with alarm symptoms
3) 24 hour pH monitoring if endoscopy normal - amount of acid coming up (refluxing) into the oesophagus from the stomach over a 24 hour period.
WHAT IS THE CONSERVATIVE MANAGEMENT FOR GORD?
1) Weight loss
2) Smoking cessation
3) Reduced alcohol consumption
4) Avoid fatty food
WHAT IS THE MEDICAL MANAGEMENT FOR GORD?
- Lifelong PPI
WHAT IS THE SURGICAL MANAGEMENT FOR GORD?
- fundoplication - fundus wrapped around GOJ, recreating physiological LOS.
WHEN IS SURGERY CONSIDERED?
- failure to respond to medical treatment/ patient preference/ patient complication
WHAT ARE THE ALARM SYMPTOMS FOR DYSPEPSIA AND ITS RELEVANCE?
Anaemia (iron deficiency) Loss of weight Anorexia Recent onset of progressive symptoms Melaena / haematemesis
Swallowing difficulty
If dyspepsia and either >55yrs or ALARM Symptoms then ENDOSCOPY
