GORD Flashcards
What is GORD?
Reflux of gastric contents (acid, bile + pepsin) back into the oesophagus, causing predominant Sx of heartburn + acid regurgitation.
What is GORD caused by aetiologically?
Transient relaxation (reduced tone) of the lower oesophageal sphincter
Increased intra-gastric pressure e.g. straining + coughing
Delayed gastric emptying
Impaired oesophageal clearance of acid.
What is ‘proven GORD’?
endoscopically determined reflux disease due to:
Oesophagitis: inflammation + mucosal erosions seen.
OR
Endoscopy -ve reflux disease (non-erosive): Sx of GORD but endoscopy is normal
List 4 risk factors for development of GORD
FH of heartburn or GORD
Obesity
Older age
Hiatus hernia.
What is the epideiomiology of GORD?
COMMON
5-10% of adults
List 2 symptoms of GORD
‘Heartburn’
Waterbrash: regurgitation of gastric contents; saliva + acid
Describe heartburn in GORD
Substernal/ epigastric burning discomfort after meals
Worse after lying down/ bending over
Relieved by antacids
What is the first line investigation for GORD?
PPI trial: Sx improvement
Further Ix indicated if no symptomatic improvement with 8w trial
Give 5 indications for upper GI endoscopy in suspected GORD
> 55y
Sx > 4w or persistent Sx despite Tx
Dysphagia
Relapsing Sx
Weight loss
What is the gold standard investigation for GORD? When should this be performed?
24h Oesophageal pH monitoring
Perform if endoscopy negative
What OGD and pH monitoring results may be seen in GORD?
OGD: Most normal (some oesphagitis)
pH: <4 more than 4% of time
List 5 conservative measures to aid management of GORD
Weight loss
Avoid trigger foods
Smoking cessation
Smaller meals + avoid large meals late in evening
Reduce alcohol
Sleep with head of bed raised
Describe management of proven GORD
Full-dose PPI for 4w
Describe management of proven severe oesophagitis
Full-dose PPI for 8w
Offer a full-dose PPI long-term as maintenance Tx
What is surgical management for refractory GORD?
Antireflux surgery: Laparoscopic fundoplication
