GI disorders (GORD, peptic ulcer, IBD, intestinal obstruction)

Question 1

What causes gastro-oesophageal reflux disease?

Answer 1

1. Reduced effectiveness of the lower oesophageal sphincter (LES):
   - reduction in resting LES tone
   - transient periods of relaxation (may be triggered by gastric
   distension)
2. Impaired oesophageal acid clearance:(does not increase reflux, but prolongs time that acid is in contact with the oesophagus)
   - reduced peristalsis, both after swallowing and between swallows - reduced saliva production eg. Elderly, dehydrated
3. Impaired resistance of the oesophageal mucosa:
   - due to reduced levels of salivary epidermal growth factor - due to damage to the mucosa from acid exposure

Question 2

State the risk factors contributing GORD.

Answer 2

1) Factors that decrease LES effectiveness:
•  Chocolate
•  Alcohol
•  Fatty food
•  Coffee, cola, tea 
•  Garlic
•  Onions
•  Cigarette smoking

2) Factors that irritate the gastric mucosa (increase gastric secretion)
•  Tomato-based products 
•  Coffee
•  Spicy foods
•  Citrus juices
•  Meds: NSAIDS, aspirin, iron, KCl, 
•  Carbonated drinks
•  Alcohol
•  Cigarette smoking

Question 3

Which of the following relaxes the lower oesophageal sphincter (more than one answer correct answer)?

Chocolate 
Carbonated drinks
Citrus juices
Onion
Spicy foods

Answer 3

Chocolate and onion

Question 4

State the symptoms contributing GORD.

Answer 4

*** Common symptoms (usually seen when pH<4)
• Heartburn
• Belching and regurgitation
• Hypersalivation

Symptoms often aggravated by lying down (i.e. gravity) e.g. patients often report worsening of symptoms at night

Less common symptoms
• Asthma (not triggered by allergens) • Chronic cough
• Hoarseness- abnormal voice changes • Pharyngitis
• Chest pain (mimics angina)

Question 5

List three factors that both decrease LES effectiveness, and irritate the gastric mucosa (increase gastric secretion).

Answer 5

Coffee, Alcohol, Cigarette smoking

Question 6

State the factors that decrease LES effectiveness.

Answer 6

• Chocolate
• Fatty food
• Cola, tea
• Garlic
• Onions

(Coffee, Alcohol, Cigarette smoking)

Question 7

State the factors that irritate the gastric mucosa (increase gastric secretion).

Answer 7

• Tomato-based products
• Spicy foods
• Citrus juices
• Meds: NSAIDS, aspirin, iron, KCl
• Carbonated drinks

(Coffee, Alcohol, Cigarette smoking)