Gastro-oesophageal Reflux Disease (GORD)

Question 1

When do you diagnose GORD?

Answer 1

2 or more weeks of acid reflux causing symptoms such as heartburn

Question 2

What are the causes / risk factors of GORD?

Answer 2

• lower oesophageal sphincter
• hiatus hernia
• loss of oesophageal peristaltic function
• abdominal obesity
• gastric acid hypersecretion
• slow gastric emptying
• overeating
• smoking
• alcohol
• pregnancy
• surgery for achalasia
• drugs
• systemic sclerosis
• helicobacter pylori

Question 3

What are the symptoms of GORD?

Answer 3

• Heartburn
• retrosternal discomfort after meals, lying, stooping or straining.
• relieved by antacids
• belching
• acid brash
• odyophagia (painful swallowing due to oesophagitis / swallowing.
• nocturnal asthma
• chronic cough
• laryngitis (hoarse voice, throat clearing)
• sinusitis

Question 4

What are the extra-oesophageal symptoms of GORD?

Answer 4

• nocturnal asthma
• chronic cough
• laryngitis (hoarse voice , clearing)
• sinusitis

Question 5

What are the complications of GORD?

Answer 5

• Oesophagitis
• ulcers
• benign strictures
• iron deficiency
• cancer (metaplasia —> dysplasia —> neoplasia)
• barrets oesophagus

Question 6

what is barrets oesophagus?

Answer 6

Change in lining of oesophagus from squamous epithelium (normal) to columnar epithelium.

• increased risk of cancer (1 in 20 men), (1 in 33 women)

Question 7

How many people with long term GORD go on to develop barret’s oesophagus?

Answer 7

1 in 20 people with GORD develop barretts.

Question 8

how common is GORD in the UK?

Answer 8

prevalence = 12 to 41 %

Question 9

What are the differentials for GORD?

Answer 9

• Oesophagitis from corrosives
• NSAIDs
• herpes
• Candida
• duodenal or gastric ulcers
• non ulcer dyspepsia
• sphincter of Oddi malfunction
• cardiac disease

Question 10

What are the investigations done for GORD/

Answer 10

1) endoscopy if : symptoms for 4+ weeks, persistent vomiting, GI bleed, iron deficiency, palpable mass, age 55+, dysphagia, symptoms relapse despite treatment, weight loss.
2) Barium swallow (hiatus hernia)
3) 24hr oesophageal ph monitoring to diagnose GORD when endoscopy normal.

Question 11

What are the lifestyle treatments for GORD?

Answer 11

1) Lifestyle:
- raise head of bed
- weight loss
- stop smoking
- small, regular meals
- avoid triggers : hot drinks, alcohol, chocolate, citrus fruits, tomatoes, spicy food, caffiene
- don’t eat <3h before bed.
- avoid drugs that affect oesophageal motility e.g. anticholinergics, Ca2+CB, nitrates
- avoid drugs that damage mucosa (NSAIDs, K+ salts, bisphosphonates)

Question 12

What are the drugs that should be avoided in GORD (they affect the oesophageal motility)?

Answer 12

• nitrates
• anticholinergics
• calcium channel blockers

***these drugs cause the lower oesophageal sphincter to relax.

Question 13

What are the drugs that should be avoided in GORD because they damage the mucosal lining?

Answer 13

• NSAIDs
• K+ salts
• Bisphosphonates

Question 14

What is the medical treatment for GORD?

Answer 14

• Antacids e.g. magnesium trisilcate
• alginates e.g. gaviscon advance
• PPI (best treatment) e.g. lansoprazole
• H2 receptor agonist e.g. cimetidine
• Prokinetic agents e.g. metoclopramide

Question 15

What does metoclopramide do?

Answer 15

metoclopramide is used as short term treatment for GORD it helps to increase rate of gastric emptying

Question 16

What are the surgical treatments for GORD?

Answer 16

• aims to increase lower oesophageal sphincture pressure

Question 17

When would endoscopy be used to investigate GORD?

Answer 17

• age 55+
• recurrent symptoms despite treatment
• palpable mass
• peristent vomiting
• GI bleed
• iron deficiency
• dysphagia
• weightloss