GORD Flashcards
How common is GORD?
10-30% of people in developed countries
What are the risk factors for GORD?
- FHx of heartburn or GORD
- Obesity
- Older age
- Hiatus hernia
- Lower oesophageal sphincter hypotension
- Stress
- Asthma
- Smoking
- Alcohol
What are the oesophageal symptoms of GORD like?
- Hearburn
- Acid regurgitation
- Bloating
- Dysphagia
- Waterbrash + acid brash
What is the heart burn like in GORD?
- burning sensation in the chest
- after meals is typical
- worse after the patient has been lying down or bending over
- at night, but is not usually
What the acid regurgitation like in GORD?
sour bitter taste usually after meals
What are the extra-oesophageal symptoms of GORD?
- Cough
- Nocturnal Asthma
- Laryngitis
- Sinusitis
What are the possible differential diagnosis of GORD?
- Acute coronary syndrome
- Stable angina
- Functional oesophageal disorder/functional heartburn
- Achalasia
- Functional (non-ulcer) dyspepsia
- Peptic ulcer disease
- Eosinophilic oesophagitis
- Proton pump inhibitor-responsive oesophageal eosinophilia
- Malignancy
- Laryngopharyngeal reflux
What is the first line investigation for GORD?
PPI trial: symptoms improve 8 week
When do you consider further investigations?
ALARM symptoms or no improvement with PPIs after 8 weeks
What other investigations do you consider and why?
- OGD: may show oesophagitis (erosion, ulcerations, strictures) or Barrett’s oesophagus
- Ambulatory pH monitoring
- Oesophageal manometry: check for motility disorders
- Barium swallow
What definitions are used to classify oesophageal syndromes?
montreal defintion
What is the 1st line treatment of acute initial presentation GORD?
- 1st line: standard dose PPI inhibitor: 8 weeks e.g. omeprazole: 20 mg orally once daily
- Plus: lifestyle changes
What is the 1st line ongoing treatment for GORD that is PPI-responsive?
continued standard dose PPI
What is the 2nd line ongoing treatment for GORD that is PPI-responsive?
- 2nd line: surgery e.g open fundoplication, laparoscopic fundoplication, magnetic sphincter augmentation
- 2nd line: transoral incisionless fundoplication
What is the 1st line treatment for incomplete response to PPI GORD?
1st line: High dose PPI + further testing
Adjunct: H2 antagonist e.g famotidine
What are the possible complications of GORD?
- Oesophageal ulcer, haemorrhage or perforation
- Oesophageal stricture
- Barrett’s oesophagus
- Adenocarcinoma of the oesophagus
What is the prognosis of GORD?
need to maintain medication compliance
What are other RF of GORD?
- Hiatus hernia
- Gastric acid hypersecretion
- Pregnancy
What is common presentation for GORD?
- Heartburn (pain in chest) after meals
- Acid regurgitation leaving bitter taste in mouth - ASK IN OSCE
- Waterbrash (increased salivation)
- Odynophagia if oesophagitis or ulceration
- Chornic cough or nocturnal asthma
What is the lifestyle management for GORD?
- Weight loss
- Smoking cessation
- Small regular meals
- Avoid food that can exacerbate
What is the medical management of GORD?
- Continue PPI was working before adding H2 blocker as well
- Antacids may be useful for symptom relief as well
What is the surgical management of GORD?
- Nissen fundoplication
- Magnetic bead band
- All forms of surgery aim to increase LOS pressure
What are other complications of GORD?
- Ulceration/perforation
- Barrett’ oesophagus
- Oesophageal cancer
What are some LOS tone reducing drugs?
- TCA’s
- Nitrates
- Anticholinergics
