GORD Flashcards
What is GORD?
Acid from the stomach refluxes through lower oesophageal sphincter + irritates lining of the oesophagus
Why is the oesophagus more sensitive to the effects of stomach acid?
- -> oesophagus lined w/ squamous epithelium
- -> stomach lined w/ columnar epithelium
Presentation?
Dyspepsia (non-specific, indigestion):
(1) Heartburn
(2) Retrosternal OR epigastric pain
(3) Acid regurgitation
(4) Bloating
(5) Nocturnal cough
(6) Hoarse voice
Action - if a patient also presents with a GI bleed (melaena or coffee ground vomiting)?
Admit for urgent endoscopy
Action - if a patient also presents with signs of cancer?
Admit for 2-ww endoscopy (endoscopy within 2 weeks)
Red flag features?
(1) DYSPHAGIA - 2ww independent of age
(2) >55yo - cut off between urgent vs. routine referral
(3) weight loss
(4) upper abdo pain + reflux
(5) indigestion resistant to treatment
(6) N&V
(7) Low Hb
(8) Raised platelet count
Lifestyle advice?
- Reduce tea/coffee/alcohol
- Weight loss
- Avoid smoking
- Smaller, regular meals
- Avoid heavy meals before bed –> sit upright after eating
Medication options?
(1) Acid neutralising –> gavison/rennie
(2) PPIs –> omeprazole/lansoprazole
Alternative medication to PPI?
Ranitidine (H2 receptor antagonist)
Surgical option (rare)
Laparoscopic fundoplication
What is Helicobacter Pylori?
Gram negative aerobic bacteria that lives in the stomach.
Can damage lining causing gastritis, ulcers + increases stomach cancer risk
How does in damage the stomach lining?
Enters and breaks gastric mucosa –> exposes epithelial lining to acid.
Produces ammonia –> directly damages epithelial lining
Who do you test for H.Pylori?
Anyone with dyspepsia - requires 2 weeks without a PPI
Tests for H.Pylori?
(1) Urea breath test (C-13)
(2) Stool antigen test
(3) Rapid urease test (CLO) - during endoscopy (alkaline pH)
Eradication regime for H. Pylori?
TRIPLE THERPAY: 1x PPI (omeprazole) 2x antibiotics (amoxicillin + clarithromycin)
For 7 days
What test can be used to test whether H.Pylori is eradicated?
C-13 breath test
Cancer most associated with H.Pylori?
Gastric cancer
Outline changes occur to Barretts oesophagus?
Lower oesophageal epithelium undergoes METAPLASIA from SQUAMOS epithelium to COLUMNAR
What typically happens to reflux symptoms if Barrett’s oesophagus develops?
Symptoms improve!
Barrett’s oesophagus puts you at risk of what?
Risk of columnar epithelium to progress to:
(1) low grade dysplasia
(2) high grade dysplasia
(3) ADENOCARCINOMA
Treatment of Barrett’s oesophagus?
PPI (omeprazole) + Endoscopic/biopsy surveillance
Treatment of Barrett’s if evidence of dysplasia?
Ablation treatment during endoscopy:
- endoscopic mucosal resection (EMR) OR
- radiotherapy ablation (photodynamic, laser, cryotherapy)
Treatment option for high-grade dysplasia Barrett’s oesophagus?
Endoscopic mucosal resection (EMR) > oesophagectomy
Most common type of oesophageal cancer in the UK/US?
Adenocarcinoma
Most common type of oesophageal cancer in the developing world?
Squamous cell cancer
Where are adenocarcinomas found in the oesophagus?
Near the gastro-oesophageal junction (lower 1/3)
Where are squamous cell cancers found in the oesophagus?
upper 2/3rds
Risk factors for adenocarcinoma (oesophagus)?
1) GORD –> Barrett’s oesophagus
2) Smoking
3) Achalasia
4) Obesity
