GORD Flashcards
risk factors for GORD
M>F
obesity
pregnancy
smoking and alcohol consumption
increasing age
spicy or fatty foods
consuming fizzy or caffeinated drinks
presentation of GORD
Burning retrosternal sensation, worse after meals, lying down, bending over, or straining.
Always check for red flag symptoms (dysphagia, weight loss, early satiety, malaise and loss of appetite)
Additional symptoms may include excessive belching, odynophagia, a chronic cough, or a nocturnal cough.
how do you diagnose GORD
Clinical diagnosis can be reached simply from a good history and resolution of symptoms after a trial of a proton-pump inhibitor.
24 hour pH testing is the gold standard for diagnosis
when does NICE guidelines suggest an urgent upper GI endoscopy
New-onset dysphagia
Aged >55 years with weight loss and either upper abdominal pain, reflux, or dyspepsia
New onset dyspepsia not responding to PPI treatment
when in patients with GORD would you consider OGD
ODG is generally used for detection of complications of the disease
new onset (particularly in older patients) or worsening despite PPI, patients should be referred for an endoscopy
what classification can be used for GORD on endoscopy
los angeles classification
conservative management of GORD
avoiding known precipitants (alcohol, coffee, fatty foods), weight loss, and smoking cessation
medical/ surgical management of GORD
PPI (tends to be life-long)
surgical if not responding to medical or not receptive of life-long medication
surgical - nissens fundoplication, dor/toupet
side effects of fundoplication
main side-effects of anti-reflux surgery are dysphagia, bloating, and inability to vomit,
however these often settle after 6 weeks in most patients, as the post-operative swelling and inflammation recedes
complications that can arrise from GORD
aspiration pneumonia, Barrett’s oesophagus, oesophageal strictures, and oesophageal cancer
what is barrets oesophagus
metaplastic change where due to repeated exposure to gastric content the stratified squamous epithelial cells of the distal oesophagus undergo change to simple columnar cells
most commonly caused by GORD
risk factors for barrets oesophagus
M>F, smoking, obesity, caucasian, hiatus hernia, over 50s
managment of barrets oesophagus
All patients given proton-pump inhibitor (typically starting at a high dose and twice daily).
lifestyle advise for GORD, stopping NSAIDs
why are patients with barrets oesophagus monitored regularly
Due to the risk of progression to adenocarcinoma
must undergo regular endoscopy
High grade dysplasia has a high risk of progressing to cancer so should be resected with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD)
