GORD

Question 1

def GORD

Answer 1

inflammation of the oesophagus caused by reflux of gastric acid and/or bile

Question 2

aetiology GORD

Answer 2

disruption of mechanisms that prevent reflux (LOS, mucosal rosette, acute angle of junction, intra-abdominal portion of the oesophagus)

prolonged oesophageal clearance contributes to 50% cases

LOS hypotension

hiatus hernia

oesophageal dysmobility eg systemic sclerosis

obesity

gastric acid hypersecretion

delayed gastric emptying

smoking

alcohol

pregnancy

H pylori

drugs - tricyclics, anticholingerics, nitrates

Question 3

epi GORD

Answer 3

common

prevalence 5-10% adults

Question 4

sx GORD

Answer 4

substernal burning discomfort or heartburn aggravated by lying supine, neding or large meals and drinking alcohol

pain relieved by antacids

belching

acid brash - acid or bile regurg

waterbrash - increased salvation

regurgitation of gastric contents

aspiration may = voice hoarseness, laryngitis, nocturnal cough and wheeze +- pneumonia (rare)

odynophagia - painful swallowing eg from oesophagitis or ulceration

dysphagia - from formation of peptic stricture after long-standing reflux

sinusitis

Question 5

signs GORD

Answer 5

usually normal exam

epigastric tenderness

wheeze on chest auscultation

dysphonia

Question 6

GORD ix

Answer 6

upper Gi endoscopy, biopsy, cytological brushings: confirm presence of oesophagitis, exclude malignancy - all pts >45

barium swallow - detect hiatus hernia. peptic stricture, extrinsic compression of oesophagus

CXR - incidental finding of hiatus hernia (gastric bubble behind cardiac shadow)

24hr oesophageal pH monitoring +- manometry when endoscopy normal - pH probe placed in lower oesophagus determones the temporal relationship between symptoms and oesophageal pH

Question 7

GORD advice

Answer 7

• lifestyle changes
• weight loss
• elevating head of bed
• avoid provoking factors
• stopping smoking
• lower fat meals
• avoiding large meals late
• stop hot drinks
• stop citrus fruits, spicy food

Question 8

medical mx gord

Answer 8

antacids (eg magnesium trisilicate mixture (10mL/8h), or alginates,eg Gaviscon® (10–20mL/8h PO)) and alginates

H2 antagonists (eg ranitidine) or PPI eg lansoprazole 30mg/24hr PO

Question 9

gord endoscopy

Answer 9

annual surveillence for Barrett’s oesophagus

stricture dilation or stenting

Question 10

surgery gord

Answer 10

antireflux surgery for symptoms despite medicine or medicine intolerance

nissen fundoplication

• fundus of stomach is wrapped around lower oesophagus and held with seromuscular sutures
• reduce hiatus hernia and reflux

novel options including laparoscopic insertion of a magnetic bead band or radiofrequency-induced hypertrophy.

all aim to increase resting LOS pressure

Question 11

things to avoid in GORD

Answer 11

Avoid drugs affecting oesophageal motility (nitrates, anticholinergics, Ca2+ channel blockers—relax the lower oesophageal sphincter) or that damage mucosa (NSAIDS, K+ salts, bisphosphonates).

Question 12

complications of GORD

Answer 12

• oesophageal ulceration
• peptic stricture
• anaemia
• Barrett’s oesophagus: metaplasia -> dysplasia -> neoplasia, 0.1–0.4%/yr of those with Barrett’s progress to oesophageal cancer (higher if dysplasia is present).
• oesophageal carcinoma
• associated with asthma and chronic laryngitis
• oesophagitis
• iron deficiency

Question 13

px gord

Answer 13

Atypical symptoms (cough, laryngitis) are less likely to improve with surgery compared to patients with typical symptoms.

50% respond to lifestyle factors alone

if need drug therapy - withdrawal associated with relapse

Twenty percent of patients undergoing endoscopy for GORD have Barrett’s oesophagus.