Gastro-oesophageal reflux disease (GORD) Flashcards
What is GORD
Reflux of acid into the oesophagus which damages the squamous epithelial lining
Is GORD common
Very common
What does GORD stand for
Gastro-oesophageal reflux disease
What are the symptoms of GORD
Heartburn
Cough
Waterbrash
Sleep disturbance
Nocturnal asthma
What is it important to remember about the presenting symptoms for GORD
There might not be any!
Is GORD more common in males or females
Males
What investigations are carried out for GORD
GORD can usually be diagnosed on the basis of the characteristic symptoms
What should you do if the patient has ALARM symptoms
Do an endoscopy
What are the alarm symptoms for GORD
Dysphagia
Odynophagia
Weight loss
Gastrointestinal bleeding
Anemia
>55 years
raised platelet
low haemoglobin
upper abdo pain
treatment resistant
What abnormal anatomy feature causes GORD
A Hiatus hernia
What is a hiatus hernia
Hiatal hernia occurs when the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm).
What can cause GORD in people with normal anatomy
Increased transient relaxations of the LOS
Decreased oesophageal clearance
Decreased tissue resistance to acid/bile
What are complications associated with GORD
Ulceration
Stricture
Glandular metaplasia (barretts)
Carcinoma
What is glandular metaplasia of the oesophagus also called
Barretts oesophagus
What are treatment options of GORD
Lifestyle measures
Pharmacological
Anti reflux surgery
What pharmacological options can treat GORD
PPI
Ranatidine
Gaviscon/Rennies
What is Barretts Oesophagus
The Metaplasia of the normal squamous epithelium of the lower oesophagus to Columnar (glandular) epithelium found in the duodenum
What causes Barretts Oesophagus
Prolonged acid exposure for about 3 years
What do the new columnar cells in barretts oesophagus secrete
Mucous
What investigation is used for Barretts oesophagus
Endoscopy
What treatment is used for Barretts Oesophagus
Endoscopic mucosal resection (EMR)
Radio frequency ablation (RFA)
What are the two types of hiatus hernia
Rolling Sliding
What happens in a sliding hiatus hernia
Sliding hiatal hernias are those in which the junction of the esophagus and stomach, referred to as the gastro- esophageal junction, and part of the stomach protrude into the chest. The junction may reside permanently in the chest, but often it juts into the chest only during a swallow.
What happens in a rolling hiatus hernia
A para-oesophageal or rolling hiatus hernia is a true herniation of the stomach into a peritoneal sac in the mediastinum. occurs when a defect in the phreno- oesophageal membrane allows a peritoneal sac to protrude alongside the oesophagus through the hiatus.
What epithelium type normally resides in the stomach
simple columnar epithelium
If the oesophagus is damaged by GORD what function gets affected
Oesophageal motility impaired Fibrosis can cause stricture and hence obstruction
What is Odynophagia
Pain when swallowing
What is dysphagia
Difficultly swallowing
