GORD

Question 1

GORD prevalence

Answer 1

• 40% have had reflux
  
  • 10% have it monthly
    
    • 5% have it weekly

Question 2

Diagnosis of GORD
What other things can assist with diagnosis?

Answer 2

clinical based on:
1. typical symptoms
2. response to acid suppression

pH/impedance studies can be used
gastroscopy when symptoms are atypical or red flag symptoms are present

Question 3

What are risk factors for GORD?

Answer 3

Age
Central obesity
Hiatus hernia
Pregnancy
Smoking and alcohol
Specific conditions: scleroderma, asthma

Question 4

Complications of GORD

Answer 4

1. Ulceration or bleeding
   
   2. Stricture or Schatzki ring
   3. Barrett’s oesophagus
   4. Adenocarcinoma of the oesophagus

Question 5

Is there benefit in routine screening for Barretts?

Answer 5

No

Question 6

Management of GORD

Answer 6

Weight loss, fatty / spicy foods, avoid late meals, elevate head of bed, antacids
Consider reducing reflux producing medications
If lifestyle modification is unsuccessful then acid suppression is used
Usually start high-dose and titrate down

Question 7

What medications promote GORD?

Answer 7

Beta agonists
Anticholinergics
TCAs
Progesterone
Diazepam
CCB

Aspirin/NSAIDs, doxycycline and bisphosphonates can cause direct damage / pill oesophagitis

Question 8

What are extraintestinal manifestations of GORD

Answer 8

ENT / respiratory
Sleep disturbance

Question 9

What surgical options are available?

Answer 9

1. Fundoplicatiion
   a. Effective
   b. 0.4% serious complications, 0.1% mortality
   c. Associated with increased flatus, limited period of dysphagia
   d. Occasionally can have severe dysphagia, inability to belch or vomit
   e. Fails over time

Question 10

Barretts oesophagus
- prevalence in general population and those with GORD
- histology
- cause

Answer 10

1-2% of general population, 10% of reflux patients
Metaplasia of cardia, gastric or intestinal subtype into oesophagus
Exposure to acid or bile

Question 11

Barrett’s Oesophagus
- relative risk of oesophageal adenocarcinoma
- yearly risk of oes adenocarcinoma

Answer 11

40-100x relative risk
0.2 to 0.5% per year

Question 12

Barrett’s oesophagus
- approach to management
- treatment for dysplasia / adenocarcinoma
- surveillance frequency

Answer 12

manage symptoms and surveil

consider mucosal ablation or oesophagectomy

Question 13

What are some of the side effects of PPIs?

Answer 13

C. diff colitis OR 1.8
Pneumonia RR 1.9
Gastroenteritis RR 2.9
Osteoporosis OR 1.5
Hypomagnasemia RR 1.4
Interstitial nephritis
Microscopic colitis

Question 14

What effect does PPI have on C diff colitis?

Answer 14

Increases the risk, as well as the risk of recurrent disease

Question 15

What are the causes of hypergastrinaemia?

Answer 15

Prolonged acid inhibition
Atrophic gastritis (Pernicious anaemia, Helicobacter pylori)
Small bowel resection
Gastin secreting tumours
Renal failure
Hypercalcaemia

Question 16

H pylori
- morphology
- tissue location
- virulence factors
- sequelae

Answer 16

spirochete
lives in antrum
CagA virulence factor
duodenal ulcers, worse gastritis

Question 17

What is the usual treatment for H. pylori?
When should eradication be tested?

Answer 17

Esomeprazole, amoxicillin, clarithromycin
Urea breath test 6 weeks after treatment completion

Question 18

What treatment options are available for treatment resistant H pylori?

Answer 18

Amoxicillin / tetracycline plus either bismuth or levofloxacin

Question 19

What are the macroscopic findings on endoscopy of eosinophilic oesophagitis?
Microscopic findings?

Answer 19

looks like a trachea, ridges
Microscopic >15 eos per HPF

Question 20

What is the treatment?

Answer 20

budesonide
6 food elimination diet (milk, wheat, egg, soy, nuts, fish)
PPI