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PHA223 (2023) > GORD > Flashcards

GORD Flashcards

1
Q

Define GORD

A

Dysfunctional relaxation of the lower oesophageal sphincter (LOS) that allows the acidic gastric contents to reflux into oesophagus leading to heartburn.

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2
Q

List the symptoms of GORD

A

Heartburn, Acid reflux, Chest pain, Feeling pain, Upper abdominal discomfort, Bloating, Difficulty swallowing, sensation of a lump in throat.

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3
Q

Describe the frequency/pattern of GORD symptoms

A

Nocturnal/ episodic

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4
Q

What can aggravate these symptoms?

A

Meals and reclining positions

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5
Q

Describe the GORD mechanisms

A
  1. Produced by generation of transient lower oesophageal sphincter relaxation (TLOSRs) in the absence of swallowing.
  2. TLORs arise from stimulation of gastric vagal mechanoreceptors allowing gastric acid, pepsin and bile to contact oesophagus epithelium.
  3. Oesophagul hypo-motility and abnormal oesophageal contractility can occur.
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6
Q

Describe the pathogenesis of GORD

A
  • lOS barrier impairment
  • TLOSRs
  • Low resting LOS pressure
  • Increased gastric pressure
  • Decreased clearance of refluxed materials
  • Decreased mucosal resistance
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7
Q

Give 3 examples of foods that contribute to decreased LOS pressure

A

Chocolate
Alcohol
Coffee

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8
Q

Give 3 examples of food/medicines that irritate gastric mucosa

A

Coffee
Spicy food
NSAIDs

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9
Q

Give 2 contributing factors that stimulate acid secretions

A

smoking
alcohol

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10
Q

List the 2 clinIcal groups of GORD

A
  • Non-erosive reflux disease
  • Erosive oesophagitis
  • Barrett’s oesophagus
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11
Q

Define erosive oesophagitis

A

Acute inflammatory Th-cell 1 response associated with oesophageal injury

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12
Q

Describe the cause of reflux cough and reflux asthma

A

Micro aspiration of gastric contents into the lungs

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13
Q

Who is Barrett’s syndrome most prevalent in?

A

adult caucasian males

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14
Q

What disease does Barrett’s syndrome increase the risk of?

A

Oesophageal adenocarcinoma

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15
Q

List the red flags of Barrett’s oesophagus

A

Bleeding, unexplained weight loss, choking, chest pain, dysphagia

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16
Q

State the aim of GORD therapy

A

Treat symptoms, reduce frequency of episodes and duration

17
Q

What are the therapeutic aims of treatment?

A
  • Increases LOS pressure
  • Enhance oesophageal mucosa
  • Decrease acidity
  • Decrease gastric volume available for reflux
18
Q

List and describe the phases of treatment

A

Phase I - lifestyle, OTC meds - antacids, H2RAs, PPIs
Phase II - pharmacological interventions - Rx H2RAs and PPIs
Phase III - Surgical interventions

19
Q

What drugs should be avoided in Pts with GORD and what should be considered?

A

AVOID: NSAIDs
CONSIDER: drugs likely to reduce LOS pressure CCBs and SSRIs

20
Q

Describe the NICE guidelines for treatment of GORD symptoms

A
  1. Offer PPI for 4/8 weeks - no response offer H2RA
  2. If severe PPI for 8 weeks - no response offer a different PPI.
21
Q

Describe the treatment in pregnancy

A
  • 1st line - dietary and lifestyle
  • Antacids/alginate
  • PPI/H2RA
22
Q

Give examples of antacids

A

MgCO3, ALCOS, CaCO3

23
Q

What are the effects of Mg and Al containing preparations and describe how can this be overcome?

A

Mg - causes diarrhoea
Al - constipation
Take Mg & Al containing antacids decreases these colonic effects

24
Q

When should antacids be taken to have prolonged effect?

A

After food - less effective due to rapids gastric emptying

25
Q

Give an example of an antifoaming agent and describe its MOA

A

Simeticone - decreases surface tension of GI gas bubbles to facilitate elimination. Acid gas dispersal.

26
Q

List 3 types of drug groups providing oesophageal mucosal resistance

A

Alginates, sucralfate, bismuth subsalicylate

27
Q

Give 2 examples of effective alginates and describe their MOA

A

Form a buoyant alginate raft to suppress reflux and relive symptoms of heartburn and GORD
EXAMPLES: Sodium alginate/bicarbonate

28
Q

Give 2 examples of mucosal protectants

A

Sucralfate and bismuth salicylate

29
Q

Describe the MOA of sucralfate

A

Release Al in the presences of acid to form a complex with mucus. Decreasing mucus degradation by pepsin and limit diffusions of H+ ions

30
Q

Describe the MOA of bismuth salicylate

A
  • Muscosa protection
  • Stimulated prostaglandins
  • Inhibits pepsin enzymatic activity
31
Q

Give 2 examples of H2RAs and describe their MOA

A

Block H2-R in gastric parietal cells and prevent acid secretion
EXAMPLESL: Ranitidine, Cimetidine

32
Q

What is the difference between PPIs and H2RAs?

A

PPIs are more effective and faster healing

33
Q

Give an example of a PPI, state the type of drug, and describe the MOA

A

Omeprazole - acid labile prodrug
The active metabolite forms covalent disulphide link with a cysteinyl residue in proton pump. Irreversible inhibition of acid secretion.

PHA223 (2023) (22 decks)

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