Gastro-oesophageal reflux disease(GORD)

Question 1

what is gastro-oesophageal reflux disease(GORD)

Answer 1

the reflux of gastric acid, pepsin bile + duodenal contents back into the oesophagus

Question 2

what are the main pathophysiologies in GORD

Answer 2

incompetent LOS(lower oesophageal sphincter), poor oesophageal clearance, visceral sensitivity

Question 3

what are the GI symptoms of GORD

Answer 3

acid reflux, heartburn, dysphagia, odynophagia, waterbrash

Question 4

describe what waterbrash and odynophagia are

Answer 4

waterbrash = sudden, unexpected saliva secretion in mouth in response to reflux symptoms
odynophagia = when act of swallowing causes pain

Question 5

what are the general symptoms of GORD(non GI)

Answer 5

weight loss, chest pain(burning), hoarseness, coughing

Question 6

describe what worsens chest pain/heartburn in GORD

Answer 6

bending, stooping or lying down, drinking alcohol or hot drinks

Question 7

describe some factors associated with GORD

Answer 7

pregnancy, obesity, large meals, smoking, fat/chocolate/alcohol ingestion, drugs

Question 8

what investigations are used for GORD

Answer 8

endoscopy, Ba swallow, oesophageal manometry and pH studies

Question 9

what are some of the complications of GORD

Answer 9

oesophageal tumours, Barrett’s oesophagus, peptic stricture

Question 10

use of what drug has resulted in the prevalence of what complication of GORD to decrease significantly, and give an example

Answer 10

PPIs(proton pump inhibitors) decrease Barrett’s oesophagus prevalence significantly
e.g. omeprazole

Question 11

what lifestyle changes can be made in the treatment of GORD

Answer 11

weight loss if overweight, smoking cessation, propping up head in bed at night, avoid eating/drinking anyhting provoking it

Question 12

what is the most commonly used over-the-counter drug for GORD, and how does it help

Answer 12

alginate-containing antacids, they form a gel or ‘foam raft’ for gastric contents to reduce reflux
used for symptomatic relief

Question 13

describe the role of H2-receptor antagonists in GORD treatment and give an example

Answer 13

used for acid suppression if antacids fail

example = cimetidine

Question 14

describe the role of PPIs(proton pump inhibitors) in GORD and give an example

Answer 14

drug of choice for all mild cases, they reduce gastric acid secretion up to 90%
example = omeprazole

Question 15

describe the benefits of Nissen fundoplication surgical technique in GORD

Answer 15

controls symptoms(70-90% patients), heals oesophagitis

Question 16

what patients is the Nissen fundolication treatment indicated for

Answer 16

young patients ,and those with severe GORD or are unresponsive