GORD Flashcards
GORD
Acid from stomach refluxes through lower oesophageal sphincter
Presentation
Heartburn
Acid regurgitation
Retrosternal or epigastric pain
Bloating
Nocturnal cough
Hoarse voice
Referral for endoscopy
2 week wait if suspicious of cancer
Red flag features
Dysphagia at any age
Aged over 55
Weight loss
Upper abdo pain/ reflux
Treatment resistant dyspepsia
Nausea and vomiting
Low haemoglobin
Raised platelet count
Lifestyle advice
Reduce tea, coffee and alcohol
Weight loss
Avoid smoking
Smaller, lighter meals
Avoid heavy meals before bed time
Stay upright after meals rather than lying flat
Treatment of endoscopically proven oesophagitis
Full dose PPI for 1-2 months
If response then low dose treatment as required
If no response then double-dose PPI for 1 month
Endoscopically negative reflux disease management
Full dose PPI for 1 month
If response then low dose treatment, possibly PRN
If no response then H2RA or prokinetic for one month
Acid neutralising medications
Gavison
Rennie
Ranitidine
H2 receptor antagonist
Reduces stomach acid
H.pylori
Gram negative aerobic bacteria
Damages epithelial lining of stomach resulting in gastritis, ulcers and increased risk of cancer
Produces ammonia
H.pylori tests
For anyone with dyspepsia
Need 2 weeks without using PPI before test
Urea breath test (radiolabelled carbon 13)
Stool antigen test
Rapid urease test during endoscopy
Rapid urease test
CLO test
Take small biopsy of stomach mucosa
Urea added to sample
If H.pylori present they produce urease enzymes convert urea to ammonia and give positive result of alkali on pH testing
H.pylori eradication
Triple therapy with PPI and 2 antibiotics (amoxicillin and clarithromycin) for 7 days
Barrets oesophagus
Acid reflux causes metaplasia from squamous to columnar epithelium
Considered premalignant
Risk factor for adenocarinoma of oesophagus
