Gastro-oesophageal Reflux Disease (GORD) Flashcards

1
Q

When do you diagnose GORD?

A

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

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2
Q

What are the causes / risk factors of GORD?

A
  • 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
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3
Q

What are the symptoms of GORD?

A
  • 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
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4
Q

What are the extra-oesophageal symptoms of GORD?

A
  • nocturnal asthma
  • chronic cough
  • laryngitis (hoarse voice , clearing)
  • sinusitis
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5
Q

What are the complications of GORD?

A
  • Oesophagitis
  • ulcers
  • benign strictures
  • iron deficiency
  • cancer (metaplasia —> dysplasia —> neoplasia)
  • barrets oesophagus
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6
Q

what is barrets oesophagus?

A

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

  • increased risk of cancer (1 in 20 men), (1 in 33 women)
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7
Q

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

A

1 in 20 people with GORD develop barretts.

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8
Q

how common is GORD in the UK?

A

prevalence = 12 to 41 %

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9
Q

What are the differentials for GORD?

A
  • Oesophagitis from corrosives
  • NSAIDs
  • herpes
  • Candida
  • duodenal or gastric ulcers
  • non ulcer dyspepsia
  • sphincter of Oddi malfunction
  • cardiac disease
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10
Q

What are the investigations done for GORD/

A

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.

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11
Q

What are the lifestyle treatments for GORD?

A

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)

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12
Q

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

A
  • nitrates
  • anticholinergics
  • calcium channel blockers

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

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13
Q

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

A
  • NSAIDs
  • K+ salts
  • Bisphosphonates
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14
Q

What is the medical treatment for GORD?

A
  • 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
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15
Q

What does metoclopramide do?

A

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

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16
Q

What are the surgical treatments for GORD?

A
  • aims to increase lower oesophageal sphincture pressure
17
Q

When would endoscopy be used to investigate GORD?

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