Gastroesophageal reflux disease GORD

Question 1

What is GORD?

Answer 1

When acid from the stomach refluxes through the lower oesophageal sphincter and irritates the membranous lining of the oesophagus

Question 2

what type of epithelium is in the oesophagus?

Answer 2

squamous epithelial

Question 3

what type of epithelium is in the stomach?

Answer 3

columnar epithelium

Question 4

how does GORD present?

Answer 4

heart burn
acid taste in mouth
epigastric pain
chest pain
nausea
vomiting
bloating
belching 
teeth erosion
DRY cough when lying down/at night 
laryngitis 
acid regurgitation
dyspepsia
change in bowel habit
hoarse voice

Question 5

What are red flag symptoms in GORD?

Answer 5

weight loss
anaemia (persistent bleed)
dysphagia (trouble swallowing)
haematamesis
malaena
persistent vomiting
Coffee ground vomiting

Question 6

What are the risk factors for GORD?

Answer 6

obesity
smoking 
alcohol
caffeine
high fatty diets
spicy foods 
citrus foods
hiatal hernia
scleroderma
Zollinger Ellison syndrome

Question 7

Which medications cause increased risk of GORD?

Answer 7

anti depressants
benzodiazepines 
calcium channel blockers
anti histamines 
glucocorticoids

Question 8

What is scleroderma?

Answer 8

when the lower oesophageal sphincter muscle is replaced with connective tissue over time

Question 9

What are the main investigations for GORD?

Answer 9

Use treatment and see if it works
24hr pH monitoring in the lower oesophagus
Endoscopy
H.Pylori tests

Question 10

What tests can be done for H.Pylori?

Answer 10

Urea breath test - using radiolabelled 13 urea
stool antigen test
rapid urease test - done during endoscopy

Question 11

How is H pylori treated?

Answer 11

Triple therapy:

PPI + 2 antibiotics

Question 12

how is GORD managed surgically?

Answer 12

nissan fundoplication - the funds of the stomach is wrapped around the lower oesophageal sphincter

Question 13

How is good managed with medication?

Answer 13

PPI - omeprazole or lansoprazole

H2 blocker - ranitidine

Question 14

What is the management advice for GORD?

Answer 14

lose weight
small frequent meals
stay upright after eating
stop smoking, drinking alcohol, high fatty diet

Question 15

when is an urgent endoscopy needed?

Answer 15

when theres evidence of a bleed:
coffee ground vomiting
malaena

Question 16

When is a 2 week wait referral needed for endoscopy?

Answer 16

When there are signs of cancer:
Dysphagia
weight loss 
>55yrs
Iron deficiency anaemia
low haemoglobin count
raised platelet count

Question 17

What should be done before testing for H pylori?

Answer 17

Should stop PPI 2 weeks before to avoid false positives

Question 18

What is Barretts oesophagus?

Answer 18

metaplasia of the endothelial cells in the oesophagus from squamous to columnar

Question 19

What is the order of cancer from tissue changes?

Answer 19

Metaplasia > dysplasia > neoplasia

Question 20

What benefit does Barretts oesophagus seem to have?

Answer 20

It causes an improvement in GORD

Question 21

What can Barretts oesophagus cause?

Answer 21

Adenocarcinoma of the oesophagus

Question 22

How often are patients with non dysplastic Barretts oesophagus monitored?

Answer 22

With endoscopy every 3 years

Question 23

how can Barretts oesophagus turn into cancer?

Answer 23

barretts oesophagus = columnar epithelium with no disyplasia -> low grade dysplasia -> high grade dysplasia -> Adenocarcinoma

Question 24

what stages of Barretts oesophagus can be treated?

Answer 24

Low grade and high grade dysplasia can be treated to prevent adenocarcinoma

Question 25

What is the treatment for Barretts oesophagus?

Answer 25

3yrly monitoring
PPI 
Regular aspirin
Ablation treatments 
Surgery