GORD

Question 1

Give some examples of criteria for referring a patient with GORD for a 2WW endoscopy

Answer 1

• Dysphagia
• Weight loss
• Treatment resistant dyspepsia
• Aged > 55

Question 2

Describe the conservative, medical and surgical management of GORD

Answer 2

Conservative:

• Smaller, lighter meals
• Avoid heavy meals before bed time
• Avoid tea, coffee, alcohol
• Smoking cessation

Medical:

• Antacid meds e.g. Gaviscon, Rennie
• PPIs, e.g. lansoprazole, omeprazole

Surgical:
- Laparoscopic fundoplication

Question 3

Which microorganism can complicate GORD?

Answer 3

Helicobacter pylori

Question 4

How do you test for H. pylori?

Answer 4

• Urea breath test
• Stool antigen test
• Rapid urease test (AKA CLO test) performed during endoscopy

Question 5

Can you test for H. pylori while a patient is on a PPI?

Answer 5

For an accurate result, the patient must NOT be taking a PPI for at least 2 weeks prior to the test

Question 6

How do you eradicate H. pylori?

Answer 6

Triple therapy with a PPI plus 2 antibiotics, e.g. omeprazole plus amoxicillin and clarithromycin

Question 7

What is Barrett’s oesophagus?

Answer 7

Complication of GORD - metaplasia from squamous to columnar epithelium (premalignant condition)

Question 8

Barrett’s oesophagus carries an increased risk of which cancer?

Answer 8

Adenocarcinoma of the oesophagus

Question 9

Describe the medical and interventional management of Barrett’s oesophagus

Answer 9

Medical:
- PPI

Interventional:
- Ablation treatment