Gastro-Oesophageal Reflux Disease (GORD) Flashcards
What is gastro-oesophageal reflex disease (GORD)?
It is defined as a condition in which gastric acid refluxes from the stomach through the lower oesophageal sphincter and irritates the lining of the oesophagus
Why is the oesophagus more sensitive to gastric acid than the stomach?
The oesophagus is lined with squamous epithelium, whereas the stomach is lined with columnar epithelium
Therefore, the stomach is more protected against gastric acid
What are the seven risk factors of GORD?
Connective Tissue Disorders
Hiatus Hernia
Obesity
Pregnancy
Smoking
Alcoholism
Caffeine Intake
What are the seven clinical features of GORD?
Heartburn
Acid Regurgitation
Dysphagia
Epigastric Pain
Abdominal Distension
Nocturnal Cough
Hoarse Voice
In most cases, how is GORD diagnosed?
Clinically
What investigation can be used to investigate GORD? When is it recommended?
Endoscopy
It is recommended when individuals present with red flag features, in order to exclude an underlying pathology or the development of complications
What are the six criteria for a two-week wait endoscopy referral?
Dysphagia
Old Age > 55 Years Old
Weight Loss
Treatment Resistance
Anaemia
Thrombocythemia
What is the criteria for an urgent endoscopy referral?
Gastrointestinal bleeding
In cases where individuals require an upper gastrointestinal endoscopy and take proton pump inhibitors, what advice should be given?
They should stop the proton pump inhibitor two weeks before the procedure
What are the five conservative management options of GORD?
Smoking Cessation
Alcohol Cessation
Caffeine Reduction
Weight Loss
Nutritional Advice
What are the three pharmacological management options of GORD?
Antacid Drugs
Proton Pump Inhibitors (PPIs)
H2 Receptor Antagonist
Name two antacid drugs used to manage GORD
Gaviscon
Rennie
When are antacid drugs used to manage GORD?
They are over the counter medications that patients can be advised to purchase
What is the mechanism of action of antacids?
They work to neutralise stomach acid and inhibit pepsin
How do antacid drugs treat GORD?
They can be administered to provide temporary symptomatic relief, however, don’t provide resolution of the underlying oesophageal damage
Name two proton pump inhibitors (PPIs) used to manage GORD
Omeprazole
Lansoprazole
When are proton pump inhibitors used to manage GORD?
They are the first line management option
How do proton pump inhibitors (PPIs) manage GORD?
They inhibit gastric acid secretion by binding to the hydrogen potassium ATPase pump that resides on the luminal surface of the parietal cell membrane
This provides time for the damaged oesophageal tissue to heal
What are three side effects of PPIs?
Osteoporosis
Fractures
Hypomagnesaemia
When is lansoprazole preferred to omeprazole to manage GORD?
When individuals are on clopidogrel
This is due to the fact that omeprazole inhibits CYP2C19 - an enzyme needed to convert clopidogrel into its active metabolite
Name a H2 receptor antagonist used to manage GORD
Ranitidine
When are H2 receptor antagonists used to manage GORD?
They are the second line management option
How do H2 receptor antagonists treat GORD?
They inhibit gastric acid secretion and by binding to histamine type 2 receptors on the basolateral surface of gastric parietal cells
This provides time for the damaged oesophageal tissue to heal
What surgery is used to manage GORD?
Laparoscopic Fundoplication
What is laparoscopic fundoplication?
It involves tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter
What are the six complications of GORD?
Oesophagitis
Oesophageal Ulcers
Oesophageal Stricture
Barrett’s Oesophagus
H.Pylori Infection
Anaemia
