GORD Flashcards
What is GORD?
Chronic condition where reflux of gastric contents - bile, acid and pepsin - back into oesophagus -> heartburn and acid regurg symptoms
What symptoms are atypical but present in GORD?
Hoarseness
Cough
Asthma
Dental erosions
What are the diagnosis of GORD on endoscopy?
Oesophagitis - orophageal inglammation and erosions seen
Endoscopy negatie reflux disease - symptoms of GORD but normal endoscopy
Pathology of GORD
transient relaxation (reduced tone) of the lower oesophageal sphincter, increased intra-gastric pressure (for example straining and coughing), delayed gastric emptying, and impaired oesophageal clearance of acid
GORD risk factors
Stress and anxiety
Smoking and alcohol
Trigger foods - coffee, chocolate, fatty foods
Obestiy
Drugs that decrease LOS pressure
Preganancy
Hiatus hernia
FH
How do coffee + chocolate vs fatty foods worsen GORD?
c+c -> lowered LOS tone,
Fatty foods - delay gastric emptying
Drugs that increase risk of GORD
Alpha blockers
Anticholinergucs
benzos
Beta blockers
Bisphosphonates
CCBs
Corticosteroids
NSAIDs
Theophyllines
Tricyclic antidepressnts
Risk factors for developing barretts oeophagus
Male
Long duration and increased frequency of GORD symptoms
Prev oesophagitis or hiatus hernia, stricutre or ulcers
Complications of GORD
Oesophageal ulcers
Oesophageal haemorrhage
Anaemia - chronic blood losss - severe oesophagitis
Oesophageal structure - fibrosis narrows lumen
Aspiration pneumonia
Barretts
Oral problems - gingivitis, eroisions, halitosis
What is barretss oesophagus?
Columnar metaplasia of distal oesophagus
Malginant potential + risk oeophageal adenocarcinoma
Lifestyle advice for GORD
Lose weight if overwieight
Avoid trigger foods - coffe, chocolate, tomatos, fatty, spicy
Smaller meals and eat evening meals 3-4 hours before going to bed
Stop smoking
Reduce alcohol consumption
Mananging GORD
Raised head of bed, not additional pillows
Assess for stress and anxiety
Ask about OTCs
Offer lifestyle advice
Review meds + consider stopping exacerbatinig
Medication management for proven GORD
Full dose PPI for 4 weeks to aid healing
Severe oesophagitis medicaiton
Full dose for 8 weeks to aid healing and as long term maintenance treatment
When are PPIs given in the day?
30 mins before breakfast and evening meal
Contraindications PPIs
-alarm symptoms before endoscopy - mask symtpoms
- stop 2 weeks before endoscopy
-at risk of osteoporosis
-at risk of hypomagnesaemia
Common Adverse effects of PPIs
Headahce, diarrhoea, nausea, vomitting, abdo pain, constipation, dizziness
Long term PPI risks serious adverse effects
hypomagnesaemia
Increased fracture risk
C difficile
Rebound hypersecretion syndrome
What else can be used to treat GORD?
H2 receptor agonists
Antacids
Antacid examples
Aluminium hydroxide, sodium bicarb, calcoium carbonate
H2 receptor antagonists examples
Ranitidne, cimetidine
Surgeries for GORD
Fundoplication - strengthen LOS by wrapping gastric fundus around it
Laprascopic insertion of magnetic bead band
Investigations GORD
FBC
Endoscopy
CXR
Barium swallow
Oeophageal pH monitoring
Why do FBC in GORD
Exclude anaemia
What is investgiation of choice GORD
Endoscopy
What can diagnose a hiatus hernia?
CXR
Barium swallow
What causes GORD?
Incompetenve of atirefluc barriers at oesophagetic juntion
Lower oesophageal sphinctre and crural diaphragm
Causes refluc of acid and irritatnts into oesophagus froms tomach
What causes severe oesophagitis?
Loss of mucosal defence mechanisms on prolonged exposure to acid
Risk factors for GORD
Stress and anxiety
Smoking
Alcohol excess
Fatty foods and coffee
Drugs that decrease LOS pressure
Pregnancy
Hiatus hernia
FH
What drugs decrease LOS pressure
Tricyclic antidepressants, anticholinergics, nitrates and CCBs
Clinical features of GORD
Heartburn - lying, stooping, straingin
trosternal discomfort
Acid brash
Water brash
Odynophagia
Chest pain/epigastric pain
Bloating
Chronic hoarseness, cough and asthmatic sym,ptoms
Acid vs water brash
Regurg of acid or bile
Excessive salivation
What does being ashkenazi jewish descent make you more likely to have?
UC
When do you get hypoalbuminaemia in UC?
Severe disease
Biologics that can be used in UC
Anti-TNFa (e.g. Infliximab)
Anti-IL-12/23 (e.g. Ustekinumab)
Anti a4b7 (e.g. Vedolizumab)
What does barretts oesophagus increase the risk of?
Oesophageal carcinoma
What does epithelium change from to in Barretts?
From squamous to columnar intestinal epithelium
What is seen on endoscopy with barretts?
Slamon coloured columnar epithelium above the gastro-oeophageal junction - at least 1 cm
What determines severity of barretts
Prague C+M classification
