Gastro-oesophageal reflux disease (GORD)

Question 1

Define Gastro-oesophageal reflux disease (GORD)

Answer 1

It is when the stomach acid refluxes through the lower oesophageal sphincter and irritates the lining of the oesophagus.

Question 2

What kind of epithelium lines the oesphagus

Answer 2

Squamous epithelial

Question 3

What kind of epithelium lines the stomach

Answer 3

columnar epithelial lining that is more protected against stomach acid.

Question 4

Why is the oesphagus more sensitive to the effects of the stomach acid

Answer 4

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.

Question 5

What is the key feature of Gastro-oesophageal reflux disease (GORD)

Answer 5

Heartburn

Question 6

What are the two key risk factors for Gastro-oesophageal reflux disease (GORD)

Answer 6

High BMI

Smoking

Question 7

The two key risk factors for Gastro-oesophageal reflux disease (GORD) are smoking and high MI.

Name some of the other fisk factors

Answer 7

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

Question 8

Heartburn is a the key symptom of Gastro-oesophageal reflux disease (GORD).

What is the classical presentation of the heartburn

Answer 8

Classically occurs after meals and is made worse by lying down or bending forward

Question 9

Name some of the clinical features of Gastro-oesophageal reflux disease (GORD)

Answer 9

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

Question 10

How is Gastro-oesophageal reflux disease (GORD) diagnosed

Answer 10

Clinical diagnosis - based on characteristic symptoms

Question 11

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)

Answer 11

Weight loss

Anaemia

Dysphagia - swallowing difficulties

New onset dyspepsia (>55 years)

Symptoms refractory to treatment

Question 12

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

Answer 12

pH monitoring

Oesophagogastroduodenoscopy (OGD)

Question 13

pH Monitoring, as an investigation of Gastro-oesophageal reflux disease (GORD), should be used in combination with

Answer 13

Gastroscopy

Question 14

Name the two techniques used for pH monitoring as an investigation for Gastro-oesophageal reflux disease (GORD)

Answer 14

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.

Question 15

Describe the 24 hour pH testing used to monitor pH levels as an investigation tool for Gastro-oesophageal reflux disease (GORD)

Answer 15

small tube inserted through the nose and positioned in lower oesophagus

Question 16

Describe the Prolonged wireless pH capsule testing used to monitor pH levels as an investigation tool for Gastro-oesophageal reflux disease (GORD)

Answer 16

insertion of pH capsule at gastro-oesophageal junction during gastroscopy. Will naturally fall off wall of oesophagus and pass through GI tract.

Question 17

Gastro-oesophageal reflux disease (GORD) has various managements options available.

Name some of these managements

Answer 17

Conservative: Lifestyle advice e.g. stop smoking

Pharmeutical: Acid neutralising medication, PPI and Rantidine

Surgical: Laparoscopic fundoplication

Question 18

Name some of the conservative lifetstyle management for Gastro-oesophageal reflux disease (GORD)

Answer 18

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

Question 19

Give an example of an acid neutralising medication used in the management of Gastro-oesophageal reflux disease (GORD)

Answer 19

Gaviscon, Rennie

Question 20

What is the mechanism of action of protor pump inhibitor (PPI)

Answer 20

Reduce acid secretion in the stomach

Examples: omeprazole, lansoprazole

Question 21

What is the cornerstone of treatment in managing Gastro-oesophageal reflux disease (GORD)

Answer 21

Proton pump inhibitors

Question 22

What drug class is Ranitidine a part of

Answer 22

H2 receptor antagonist

Question 23

PPI vs Ranitidine in the management of Gastro-oesophageal reflux disease (GORD)

Answer 23

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.

Question 24

Laparoscopic fundoplication is a surgical intervention for managing Gastro-oesophageal reflux disease (GORD).

What is involved

Answer 24

Involves tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter

Question 25

In what patients group is Laparoscopic fundoplication a potential option in managing Gastro-oesophageal reflux disease (GORD)

Answer 25

Generally reserved for patients with clear evidence of reflux or associated complications

Question 26

Name some of the complications of Laparoscopic fundoplication

Answer 26

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