Gastro-oesophageal reflux disease (GORD) Flashcards

1
Q

What is GORD?

A

Abnormal acid reflux where acid from the stomach refluxes into the oesophagus subsequently damaging the squamous oesophageal lining, causing discomfort.

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2
Q

What are the signs and symptoms of GORD?

A
Heartburn: pain is worse in certain positions, e.g. lying down/stooping and is worse after heavy meals.
Acid taste in mouth- regurgitation.
Water brash (excess salivation).
Dysphagia.
Nocturnal asthma/ chronic cough.
Laryngitis.
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3
Q

What are the causes of GORD?

A

Genetic inheritance of angle of lower oesophageal sphincter.
Oesophagitis.
Sliding hiatus hernia.
Rolling hiatus hernia.

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4
Q

What are the risk factors for GORD?

A
Smoking
Excessive alcohol
Excessive coffee
Obesity
Pregnancy
Drugs, e.g. calcium channel blockers, anti-muscarinics and tricyclic antidepressants.
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5
Q

What investigations should be performed for suspected GORD?

A

Age dependent.
If patient is <55 years old, proceed to treatment unless they have ALARM symptoms, e.g. unintentional weight loss, dysphagia, haematemesis, melaena and anorexia.
If >55 years old, send patient to endoscopy (diagnostic and allows for biopsy) and start 24h pH monitoring.

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6
Q

What is the conservative treatment of GORD?

A

Education
Weight loss
Raising head of bed at night
Avoidance of precipitating factors, e.g. smoking, large meals.

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7
Q

What is the medical treatment of GORD?

A

Antacids, e.g. aluminium hydroxide.
H2 receptor antagonists, e.g. ranitidine.
Proton pump inhibitors, e.g. omeprazole.

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8
Q

What is the surgical treatment of GORD?

A

Nissen’s fundoplication.

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9
Q

What is a complication of GORD?

A

Barrett’s oesophagus.

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10
Q

What is Barrett’s oesophagus?

A

Metaplasia of the normal squamous epithelium of the lower oesophagus to columnar epithelium. Occurs in patients who suffer with GORD for several years. It is a premalignant lesion.

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11
Q

What investigation is performed to confirm Barrett’s oesophagus?

A

Endoscopy with biopsy in all 4 quadrants.

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12
Q

What is the treatment of Barrett’s oesophagus?

A

HALO system radiofrequency ablation or mucosal resection for highly dysplastic lesions.

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13
Q

What is a complication of Barrett’s oesophagus?

A

Adenocarcinoma of the oesophagus.

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