GORD Flashcards
ESSENCE
Where acid from stomach refluxes through lower oesophageal spincter, irritating linging of oestophagus
Why is oesophagus susceptible to effects of stomach acid more than stomach
It has squamous epithelial lining
Stomach has columnar epithelial lining that is more protected
AETIOLOGY
Risk factors
- FH GORD or heartburn
- Older age
- Hiatus hernia
- Obesity
EPIDEMIOLOGY
Prevalence
Common condition affecting 10-30% people in developed countries
CLINICAL FEATURES
Presentation
- Dyspepsia is non-specific term to describe indigestion, covering GORD symptoms
- Heartburn
- Acid regurgitation
- Retrosternal or epigastric pain
- Bloating
- Nocturnal cough
- Hoarse voice
INVESTIGATIONS
First choice
- Usually clinical diagnosis
- Endoscopy maybe to assess peptic ulcers or any malignancy if concerning features
What are red flag features for malignancy when refering
- Dysphagia
- Age > 55
- Weight loss
- Upper abdominal pain/reflux
- Treatment resistant dyspepsia
- Nausea and vomiting
- Low haemoglobin
- Raised platelet count
MANAGEMENT
General principles
- Lifestyle advice
- Acid neutralising medication when required
- Proton pump inhibitors
- Maybe ranitidine instead
- Surgery maybe
MANAGEMENT
Lifestyle advice
- Reduce tea, coffee and alcohol
- Weight loss
- Avoid smoking
- Smaller, lighter meals
- Avoid heavy meals before bed
- Stay upright after meals
MANAGEMENT
Acid neutralising medication options
- Gaviscon
- Rennie
MANAGEMENT
Proton pump inhibitor options
- Omeprazole
- Lansoprazole
MANAGEMENT
Surgery options
- Laparoscopic fundoplication
- Tying fundus of stomach around lower oesophagus to narrow the sphincter
MANAGEMENT
Lines for acute management
- 1) PPI plus lifestyle changes
MANAGEMENT
Lines for ongoing management when PPI response
- 1) Continue standard dose PPI
- 2) Surgery
MANAGEMENT
Lines for ongoing management when no reponse to PPI
- 1) High dose PPI and further testing
- If nocturanl component addd H2 antagonist (Ranitidine)
