GORD Flashcards
What is GORD and its symptoms?
- Reflux of gastric contents into oesophagus due to defective lower oesophageal sphincter
- Symptoms include: Dyspepsia, sensation of acid regurg, laryngitis, epigastric/chest pain, bloating, belching
What are red flag symptoms in GORD?
Weight loss
Anaemia
Dysphagia
Haematemesis
Melaena
Persistent vomiting
What are the risk factors for GORD?
- Obesity,
- Alcohol use,
- Hiatus hernia,
- smoking
- Spicy or fatty foods
What are the differential diagnoses for GORD?
- Gastric ulcers,
- ACS,
- Oesophageal cancer,
- Functional dyspepsia,
- Achalasia
What are the investigations for GORD?
1st - PPI trial for 8 weeks then endoscopy if no response
Others: OGD, oesophageal manometry
What is the management of GORD
- Lifestyle advice
- PPI therapy (full dose for 1-2 months. If response then lower dose, if no response then double up for 1 month)
What are the complications of GORD?
- Oesophageal ulcer,
- Barret’s oesophagus,
- oesophageal stricture
- Adenocarcinoma of oesophagus
What are the two types of hiatus hernia’s?
- Sliding (GOJ moves above diaphragm)
- Rolling (GOJ is below diaphragm but a separate part of stomach herniates through oesophagus)
What are the risk factors for hiatus hernia?
Obesity
Increased intra-abdominal pressure (ascities or multiparity)
What are the features of hiatus hernias?
Heartburn
Dysphagia
Regurgitation
Chest pain
Bowel sounds in chest
( Can present with cough, SOB)
What are the investigations for hiatus hernia?
- Barium swallow is best however most patients are diagnosed via endoscopy
- Chest X ray
What is the management of hiatus hernia?
- Conservative management (weight loss, elevating head of bed, avoid large meals 3h before bed, smoking cessation)
- Medical management = PPI
- Surgical management - only in symptomatic paraoesophageal hernia
