GI reflux Flashcards
What is Gastro-oesophageal reflux disease?
Reflux of the stomach contents (acid +- bile) into the oesophagus causes symptoms of >2 heartburn episodes per week and/or complications.
what causes GORD?
- Lower esophageal sphincter hypo tension
- Hiatus hernia
- Loss of oesophageal peristaltic function
- Gastric acid hyper-secretion
- Slow gastric emptying
- Abdominal obesity
What factors predispose GORD?
- Over eating
- Pregnancy
- smoking
- Drugs -> tricyclics, anti-cholinergic, nitrates.
What are the main symptoms?
- Heart burn
- Acid or bile regurgitation
- water brush (increase salivation in mouth)
- Belching
- odynophagia
what is heart burn?
Burning, retro-sternal discomfort after meals, lying down, stooping or straining. It is relived by antacids.
What is odynophagia?
painful swallowing due to oesophagitis or ulceration
what are extra-oesophgeal symptoms?
- nocturnal asthma
- chronic cough
- laryngitis (hoarseness, clearing)
- sinusitis
Why can you sometimes get nocturnal asthma and cough?
They occur when the gastric contents have been aspirated into the lungs.
what are the complications of GORD?
- oesophagitis
- ulcers
- benign stricture
- iron deficiency
- Barrett’s oesophagus
what is a benign stricture?
It is the narrowing/ tightening of the oesophagus that causes swallowing difficulties. It presents with gradually worsening dysphagia. It is treated with endoscopic dilation and PPI therapy
What is Barrett;s oesophagus?
Abnormal columnar epithelium (red colored) replace the squamous epithelium (pale, glossy) that line the distal oesophagus. It is diagnose by endoscopic appearance and biopsies. It is pre-malignant. It is treated with PPI and oesophagus surveillance every 2 years with multiple biopsies.
Differential diagnosis?
- oesophagitis from corrosives, NSAID’s, herpes.
- duodenal/ Gastric ulcers.
- non-ulcer dyspepsia
- sphincter of oddi malfunction.
5, cardiac disease
How to diagnose GORD?
Diagnosis is clinical and most people are treated without investigations.
When should an endoscopy be done?
- if have symptoms ? 4wks
- persistent vomiting
- GI bleeding
- palpable mass.
- age >55
- dysphagia
- symptoms despite treatment
- relapsing symptoms.
If endoscopy is normal, what other investigation can confirm GORD as a diagnosis?
pH monitoring +- manometry
What lifestyle changes can be made to treat GORD?
- raising bed head +- weight loss
- smoking cessation
- small regular meals.
- Avoid hot drinks, alcohol, spicy foods etc.
- Avoid drugs like nitrates, anti-cholinergics etc.
How and which drugs affect esophageal motility?
Nitrates, anti-cholinergics, and Ca+ channel blockers relax the lower esophageal sphincter.
NAID’s, K+ salts, bisphosphonates damage mucosa
What is the first line drug treatment?
Alginate containing antacids for symptomatic relief of heart burn.
Mechanism is antacids?
it buffers stomach acid
mechanism of alginates?
it increases the viscosity of the stomach contents, which reduces the reflux of stomach acid into the oesphagus. after reacting with stomach acid, they from a floating raft that separates the gastric contents from the gastro-oesphgeal junction to prevent mucosal damage.
What treatment is given for mild symptoms?
life style changes and antacids.
what treatment is given for severe symptoms or complications?
PPI’s provide symptomatic relief of dyspepsia and GORD
mechanism of PPI’s?
Reduce gastric acid secretion. They act by irreversible binding to H+/K+-ATPase in gastric parietal cells, which is the proton pump that secrets H+ and produces gastric acid.
Why are PPI’s so effective?
They target the final stage of gastric acid production, thus are able to suppress gastric acid production completely.
what treatment is given for patients who continue to have symptoms after having medical treatment?
Surgery
What is the aim for surgery?
Aims to increase resting lower oesophgeal sphincter pressure.
Name a surgical procedure?
Nissen fundoplication. The fundus of stomach is sutured around the lower oesphagus and anti reflux valve is inserted. Complication are dysphagia and bloating.
