GORD

Question 1

Presentation of GORD

Answer 1

Heartburn
Acid regurgitation
Retrosternal or epigastric pain
Bloating
Nocturnal cough
Hoarse voice

Question 2

When to refer for endoscopy as 2WW

Answer 2

They key red flag features indicating referral are:

Dysphagia (difficulty swallowing) at any age gets a two week wait referral

Aged over 55 with weight loss and any of these:

• Upper abdominal pain
• Dyspepsia
• Reflux

Question 3

Management of GORD

Answer 3

Lifestyle advice:

• Reduce caffeine
• Reduce alcohol
• Weight loss
• Avoid smoking
• Smaller lighter meals
• Stay upright after meals
• Gaviscon/Rennie as needed

PPIs - first line
- Full dose PPI for 4-8w (if there is a response but symptoms then recur continue on lowest possible dose PPI)

• Second line is Ranitidine (H2 receptor antagonist) (if no response to PPI)

Question 4

How do PPIs and H2 receptor antagonists work?

Answer 4

PPIs - reduce acid secretion in the stomach

H2 receptor antagonist (antihistamine) - reduces stomach acid

Question 5

Investigations to do in GORD

Answer 5

Offer an H. Pylori test:

• CLO test during endoscopy
• Urea breath test
• Stool antigen test

Need 2 weeks without PPI use before H. Pylori test for an accurate result

Question 6

Potential surgical management in GORD

Answer 6

Laparoscopic fundoplication - fundus of stomach tied around lower oesophageal sphincter to narrow it

Question 7

How is H. Pylori treated?

Answer 7

Triple therapy - PPI plus 2 antibiotics (e.g. amoxicillin and clarithromycin) for 7 days.

Question 8

What are potential complications of GORD?

Answer 8

Barrett’s oesophagus
Oesophagitis
Stricture formation
Ulceration

Question 9

What is Barrett’s oesophagus?

Answer 9

Metaplasia from squamous to a columnar epithelium in the oesophagus

It is a pre-malignant condition and a RF for developing adenocarcinoma of the oesophagus

Question 10

How is Barrett’s oesophagus treated?

Answer 10

Regular endoscopy to monitor for any dysplastic chance towards adenocarcinoma

PPIs

Ablation treatment during endoscopy using photodynamic therapy, laser therapy or cryotherapy is used to destroy the epithelium so that it is replaced with normal cells. This is not recommended in patients with no dysplasia but has a role in low and high grade dysplasia in preventing progression to cancer.