GORD

Question 1

red flags in GORD

Answer 1

recurrent vomiting
dysphagia or odynophagia
weight loss
GI blood loss (haematemesis, iron deficiency anaemia)
duration of symptoms >5 years or <6 months
epigastric mass
age > 50 years

Question 2

lifestyle modification

Answer 2

weight loss
elevation of the head of the bed
avoidance of food 2-3 hours before bedtime if there are nocturnal symptoms
drugs with anticholinergic or smooth muscle relaxing properties may exacerbate symptoms
antacids
avoid foods that trigger symptoms.
cesstion of tobacco and alcohol are recommended but have nnot been shown to improve symptoms

Question 3

management of GORD

Answer 3

trial of proton pump inhibitor for 4-8 weeks
take 30-60 minutes before food for optimal effect

Question 4

if symptoms are controlled following acid suppression therapy

Answer 4

attempt to withdraw acid suppression therapy
if symptoms recur, use the minimum dose that controls symptoms

Question 5

risk factors for GORD

Answer 5

obesity
advanced age
male gender
cuacasian
diets high in fats, sugars and salts
smoking

Question 6

pathophysiology of GORD

Answer 6

defective function of the lower oesophageal sphincter leads to excessive acid exposure in the lower oesophagus during transient lower oesophageal relaxations

Question 7

symptoms of GORD

Answer 7

heartburn and regurgitation
in a small minority, there may be complications of peptic oesophagitis may occur such as oesophageal strictures, barret’s oesophagus, and rarely oesophageal adenocarcinoma

Question 8

increased risk of oesophageal adenocarcinoma

Answer 8

increased fivefold in patients. with chronic GORD compared to the rest of the population

Question 9

further investigation is required for patients who

Answer 9

do not respond to trial of acid suppression
have red flags
have chronic symptoms

Question 10

gastroscopy is used to look for

Answer 10

complications or exclude other dignosis
normal endoscopy does not exclude GORD

Question 11

what has gastroscopy exclude

Answer 11

gastroscopy can exclude barrett’s oesophagus and erosive GORD

Question 12

indications for gastroscopy

Answer 12

persistent symptoms despite PPI
treatment complications such as dilatation of oesophageal strictures
treatment complications such as dilatatiion of oesophageal strictures
evaluation before and after surgical procedures
screening for barrett’s oesophagus in high risk ptients
biopsy may be needed to exclude eosinophilic oesophagitis

Question 13

is helicobacter pylori eradicatio effective for GORD

Answer 13

no, helicobacter pylori may actually be protective against GORD

Question 14

pharmacology of PPIs

Answer 14

more potent at acid suppression than H2 receptor antagonists
irrevrsibly bind to and block the proton pump (H+/K+-ATPase exchange)
have a short half life and are only effective when the proton pumps are active (postprandial period)

Question 15

surgical management is indictaed whe

Answer 15

indications for anti-reflux surgery include refractory symtpoms despite maximal medical mangement or symptomatic complications unresponsive to medical therapy

Question 16

surgical management is usually

Answer 16

laparoscopic fundoplication
involves the ocnstruction of a cuff of gastric (fundus) tissue around the lower oesophageal sphincter junction