Gastroesophageal reflux

Question 1

What is gastroesophageal reflux & what does it result in?

Answer 1

Reflux of gastric acid into oesophagus (can be from hiatus hernia)
Leads to:
- Thickening of squamous epithelium - protective mechanism
- Ulceration of oesophageal epithelium - if severe & persistent

Question 2

Complications of reflux?

Answer 2

Healing by fibrosis = no muscle, not motile, no peristalsis
–> Stricture formation, impaired motility & obstruction

Barrett’s oesophagus

Question 3

What is Barrett’s oesophagus?

Answer 3

Type of metaplasia (squamous epithelium transformed to glandular epithelium)
An attempt at protection from reflux

Question 4

Why is Barrett’s oesophagus concerning?

Answer 4

Pre malignant

Question 5

Treatment of Barrett’s oesophagus?

Answer 5

Endoscopic mucosal resection
Radio-frequency ablation (RFA)
Oesophagectomy (rarely)

Question 6

Mortality of oesophagectomy?

Answer 6

Approx 10%

Question 7

Symptoms of GO reflux?

Answer 7

Many asymptomatic
Heartburn
Cough
Sleep disturbance
Bloating
Dysphagia

Question 8

What is water brash?

Answer 8

Regurgitation of excessive accumulation of saliva of lower oesophagus with some acid material from stomach

Question 9

Risk factors of GO reflux?

Answer 9

Pregnancy
Obesity
Drugs lowering LOS pressure
Smoking
Alcoholism
Hypomotility (more food left in stomach)

Question 10

Incidence (gender & race) of GO reflux?

Answer 10

Men > Women

Caucasian > Black > Asian

Question 11

How is GO reflux diagnosed?

Answer 11

Can be diagnosed from symptoms alone

Endoscopy if ALARM symptom

Question 12

What investigation is done for GO reflux if ALARM symptom present?

Answer 12

Endoscopy - poor diagnostic test of GO reflux as little evidence

Question 13

What are the GI ALARM symptoms?

Answer 13

Age > 50 with new onset
FH of upper GI cancer
Unintended weight loss
GI bleed or anaemia
Progressive dysphagia
Odynophagia
Persistent vomiting
Palpable mass or lymphadenopathy
Jaundice

Question 14

What is dysphagia?

Answer 14

Difficulty swallowing

Question 15

What is odynophagia?

Answer 15

Pain when swallowing

Question 16

Causes of GO reflux?

Answer 16

Anything that causes too much relaxation in LOS or Stomach empties too slowly or increased tissue sensitivity.
Hiatus hernia

Question 17

Treatment of GO reflux?

Answer 17

Lifestyle measures
Pharmacological = 
- Alginates (gaviscon)
- H2RA (Ranitidine)
- PPI (omeprazole, lansoprazole)
Anti reflux surgery - for refractory disease/symptoms

Question 18

Signs of GO reflux?

Answer 18

Bad breath
Laryngitis
Water brash