Gastroesophageal reflux disease GORD Flashcards
What is GORD?
When acid from the stomach refluxes through the lower oesophageal sphincter and irritates the membranous lining of the oesophagus
what type of epithelium is in the oesophagus?
squamous epithelial
what type of epithelium is in the stomach?
columnar epithelium
how does GORD present?
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
What are red flag symptoms in GORD?
weight loss anaemia (persistent bleed) dysphagia (trouble swallowing) haematamesis malaena persistent vomiting Coffee ground vomiting
What are the risk factors for GORD?
obesity smoking alcohol caffeine high fatty diets spicy foods citrus foods hiatal hernia scleroderma Zollinger Ellison syndrome
Which medications cause increased risk of GORD?
anti depressants benzodiazepines calcium channel blockers anti histamines glucocorticoids
What is scleroderma?
when the lower oesophageal sphincter muscle is replaced with connective tissue over time
What are the main investigations for GORD?
Use treatment and see if it works
24hr pH monitoring in the lower oesophagus
Endoscopy
H.Pylori tests
What tests can be done for H.Pylori?
Urea breath test - using radiolabelled 13 urea
stool antigen test
rapid urease test - done during endoscopy
How is H pylori treated?
Triple therapy:
PPI + 2 antibiotics
how is GORD managed surgically?
nissan fundoplication - the funds of the stomach is wrapped around the lower oesophageal sphincter
How is good managed with medication?
PPI - omeprazole or lansoprazole
H2 blocker - ranitidine
What is the management advice for GORD?
lose weight
small frequent meals
stay upright after eating
stop smoking, drinking alcohol, high fatty diet
when is an urgent endoscopy needed?
when theres evidence of a bleed:
coffee ground vomiting
malaena
When is a 2 week wait referral needed for endoscopy?
When there are signs of cancer: Dysphagia weight loss >55yrs Iron deficiency anaemia low haemoglobin count raised platelet count
What should be done before testing for H pylori?
Should stop PPI 2 weeks before to avoid false positives
What is Barretts oesophagus?
metaplasia of the endothelial cells in the oesophagus from squamous to columnar
What is the order of cancer from tissue changes?
Metaplasia > dysplasia > neoplasia
What benefit does Barretts oesophagus seem to have?
It causes an improvement in GORD
What can Barretts oesophagus cause?
Adenocarcinoma of the oesophagus
How often are patients with non dysplastic Barretts oesophagus monitored?
With endoscopy every 3 years
how can Barretts oesophagus turn into cancer?
barretts oesophagus = columnar epithelium with no disyplasia -> low grade dysplasia -> high grade dysplasia -> Adenocarcinoma
what stages of Barretts oesophagus can be treated?
Low grade and high grade dysplasia can be treated to prevent adenocarcinoma
What is the treatment for Barretts oesophagus?
3yrly monitoring PPI Regular aspirin Ablation treatments Surgery
