Gastro-oesophageal reflux disease (GORD) Flashcards
Define Gastro-oesophageal reflux disease (GORD)
It is when the stomach acid refluxes through the lower oesophageal sphincter and irritates the lining of the oesophagus.
What kind of epithelium lines the oesphagus
Squamous epithelial
What kind of epithelium lines the stomach
columnar epithelial lining that is more protected against stomach acid.
Why is the oesphagus more sensitive to the effects of the stomach acid
The oesophagus has a squamous epithelial lining it is more sensitive to the effects of the stomach acid.
Whereas, the stomach has a columnar epithelial lining that is more protected against stomach acid.
What is the key feature of Gastro-oesophageal reflux disease (GORD)
Heartburn
What are the two key risk factors for Gastro-oesophageal reflux disease (GORD)
High BMI
Smoking
The two key risk factors for Gastro-oesophageal reflux disease (GORD) are smoking and high MI.
Name some of the other fisk factors
Lifestyle factors e.g. obesity, trigger foods, alcohol, coffee, stress
Drugs that decrease the lower oesophageal sphincter pressure e.g. calcium channel blockers (amlodipine), anticholinergics (atropine), theophylline, benzodiazepine, nitrates
Genetic association
Pregnancy
Hiatus hernia: part of the upper stomach pushes up through the diaphragm
Heartburn is a the key symptom of Gastro-oesophageal reflux disease (GORD).
What is the classical presentation of the heartburn
Classically occurs after meals and is made worse by lying down or bending forward
Name some of the clinical features of Gastro-oesophageal reflux disease (GORD)
Acid regurgitation
Dyspepsia i.e. indigestion
Pain either in the: chest, retrosternal or epigastric
Dysphagia i.e. difficulty swallowing
Odynophagia i.e. painful swallowing
Bloating
Nocturnal cough
Hoarse voice
Nausea and/or vomiting
How is Gastro-oesophageal reflux disease (GORD) diagnosed
Clinical diagnosis - based on characteristic symptoms
Name some of the red flag symptoms that make you think that an alternative diagnosis may be more likely e.g. malignancy of the upper GI tract and complications of GORD (i.e. stricture, Barrett’s)
Weight loss
Anaemia
Dysphagia - swallowing difficulties
New onset dyspepsia (>55 years)
Symptoms refractory to treatment
Diagnosis of Gastro-oesophageal reflux disease (GORD) is based on characteristics symptoms.
If the diagnosis is uncertain or if red flag symptoms are present what two investigations can be used
pH monitoring
Oesophagogastroduodenoscopy (OGD)
pH Monitoring, as an investigation of Gastro-oesophageal reflux disease (GORD), should be used in combination with
Gastroscopy
Name the two techniques used for pH monitoring as an investigation for Gastro-oesophageal reflux disease (GORD)
24-hour pH testing – small tube inserted through the nose and positioned in lower oesophagus
Prolonged wireless pH capsule testing – insertion of pH capsule at gastro-oesophageal junction during gastroscopy. Will naturally fall off wall of oesophagus and pass through GI tract.
Describe the 24 hour pH testing used to monitor pH levels as an investigation tool for Gastro-oesophageal reflux disease (GORD)
small tube inserted through the nose and positioned in lower oesophagus
Describe the Prolonged wireless pH capsule testing used to monitor pH levels as an investigation tool for Gastro-oesophageal reflux disease (GORD)
insertion of pH capsule at gastro-oesophageal junction during gastroscopy. Will naturally fall off wall of oesophagus and pass through GI tract.
Gastro-oesophageal reflux disease (GORD) has various managements options available.
Name some of these managements
Conservative: Lifestyle advice e.g. stop smoking
Pharmeutical: Acid neutralising medication, PPI and Rantidine
Surgical: Laparoscopic fundoplication
Name some of the conservative lifetstyle management for Gastro-oesophageal reflux disease (GORD)
Reduce tea, coffee and alcohol
Weight loss
Avoid smoking
Smaller, lighter meals
- Avoid eating within two hours of sleep and elevation of the head of the bed
- Stay upright after meals rather than lying flat
Give an example of an acid neutralising medication used in the management of Gastro-oesophageal reflux disease (GORD)
Gaviscon, Rennie
What is the mechanism of action of protor pump inhibitor (PPI)
Reduce acid secretion in the stomach
Examples: omeprazole, lansoprazole
What is the cornerstone of treatment in managing Gastro-oesophageal reflux disease (GORD)
Proton pump inhibitors
What drug class is Ranitidine a part of
H2 receptor antagonist
PPI vs Ranitidine in the management of Gastro-oesophageal reflux disease (GORD)
Both medications work by blocking and decreasing the production of stomach acid, but PPIs are considered stronger and faster in reducing stomach acids.
However, H2 receptor blockers specifically decrease the acid released in the evening, which is a common contributor to peptic ulcers.
Laparoscopic fundoplication is a surgical intervention for managing Gastro-oesophageal reflux disease (GORD).
What is involved
Involves tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter
In what patients group is Laparoscopic fundoplication a potential option in managing Gastro-oesophageal reflux disease (GORD)
Generally reserved for patients with clear evidence of reflux or associated complications
Name some of the complications of Laparoscopic fundoplication
Erosive oesophagitis: Inflammation of the oesophagus, which can lead to ulcers, bleeding and peptic stricture formation
Stricture: scarring and narrowing of the oesophagus due to repeated damage. Can cause dysphagia. May require dilatation or stenting
