GORD

Question 1

What is GORD?

Answer 1

Gastro-oesophageal reflux disease
Pathological acid and bile exposure in the lower oesophagus
Causes increased cell loss and inflammation

Question 2

What are the symptoms?

Answer 2

Heartburn
Belching
Cough
Acid brash
Water brash
Sleep disturbance

Question 3

What are the risk factors and why?

Answer 3

Pregnancy
Obesity
Drugs
Smoking
Alcoholism
Hypomotility

All increase intra-abdominal pressure

Question 4

What is a hiatus hernia?

Answer 4

Anatomical distortion of oesophageal-gastric junction
2 types:
1. Sliding (80%)- GO junction slides up into chest
2. Para-oesophageal (20%)- GO junction remains in abdomen but a bulge of stomach herniates into chest alongside oesophagus

Question 5

What is Barret’s oesophagus?

Answer 5

Distal oesophageal epithelium undergoes metaplasia from squamous to columnar
Precursor to dysplasia/adenocarcinoma

Question 6

What are the investigations?

Answer 6

Endoscopy
Oesophageal pH studies and manometry

Question 7

What is the lifestyle treatment?

Answer 7

Weight loss
Smoking cessation
Small, regular meals
Diet
Raise the bed head

Question 8

What is the pharmacological treatment?

Answer 8

Antacids- magnesium trisilicate mixture
Alginates- Gaviscon
PPI- lansoprazole
H2 blocker- ranitidine

Question 9

What is the surgical treatment?

Answer 9

Laparoscopic fundoplication’s
Laparoscopic insertion of a magnetic bead band
Radiofrequency induced hypertrophy