GORD Flashcards
What is GORD?
Gastro-oesophageal reflux disease (GORD) is where acid from the stomach flows through the lower oesophageal sphincter and into the oesophagus, where it irritates the lining and causes symptoms.
What cells line the stomach?
Columnar epithelial cells
What factors exacerbate GORD? (8)
• Greasy and spicy foods
• Coffee and tea
• Alcohol
• Non-steroidal anti-inflammatory drugs
• Stress
• Smoking
• Obesity
• Hiatus hernia
What is the presentation of GORD?
Dyspepsia
What symptoms does dyspepsia cover? (6)
○ Heartburn
○ Acid regurgitation
○ Retrosternal or epigastric pain
○ Bloating
○ Nocturnal cough
○ Hoarse voice
What are the key red flag features in GORD? (10)
• Dysphagia (difficulty swallowing) at any age gets an immediate two week wait referral
• Aged over 55 (this is generally the cut-off for urgent versus routine referrals)
• Weight loss
• Upper abdominal pain
• Reflux
• Treatment-resistant dyspepsia
• Nausea and vomiting
• Upper abdominal mass on palpation
• Low haemoglobin (anaemia)
• Raised platelet count
What is a hiatus hernia?
herniation of the stomach up through the diaphragm
What are the 4 types of hiatus hernia?
• Type 1: Sliding
• Type 2: Rolling
• Type 3: Combination of sliding and rolling
• Type 4: Large opening with additional abdominal organs entering the thorax
What is a type 1 hiatus hernia?
A sliding hiatus hernia is where the stomach slides up through the diaphragm, with the gastro-oesophageal junction passing up into the thorax.
What is a type 2 hiatus hernia?
A rolling hiatus hernia is where a separate portion of the stomach (i.e., the fundus), folds around and enters through the diaphragm opening, alongside the oesophagus.
What is a type 4 hiatus hernia?
Type 4 hiatus hernia refers to a large hernia that allows other intra-abdominal organs to pass through the diaphragm opening (e.g., bowel, pancreas or omentum).
Why might a hiatus hernia not be seen on imaging?
They can be intermittent
What imaging can show a hiatus hernia? (4)
○ Chest x-ray
○ CT scan
○ Endoscopy
○ Barium swallow test
What lifestyle changes are given in GORD? (6)
○ Reduce tea, coffee and alcohol
○ Weight loss
○ Avoid smoking
○ Smaller, lighter meals
○ Avoid heavy meals before bedtime
○ Stay upright after meals rather than lying flat
What are the management of GORD? (6)
• Lifestyle changes
• Reviewing medications (e.g., stop NSAIDs)
• Antacids (e.g., Gaviscon, Pepto-Bismol and Rennie) – short term only
• Proton pump inhibitors (e.g., omeprazole and lansoprazole)
• Histamine H2-receptor antagonists (e.g., famotidine)
• Surgery
What is the surgery for GORD?
Surgery for reflux is called laparoscopic fundoplication. This involves tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter.
What type of bacteria h.pylori?
Gram negative aerobic bacteria
How does h.pylori damage the stomach?
It causes damage to the epithelial lining, resulting in gastritis, ulcers and an increased risk of stomach cancer. It avoids the acidic environment by forcing its way into the gastric mucosa, using flagella to propel itself. It creates gaps in the mucosa, exposing the epithelial cells underneath to damage from stomach acid.
What does h.pylori produce?
Ammonium hydroxide which neutralises the acid surrounding the bacteria
Toxins
What should be done before testing for h.pylori?
Stop taking PPIs for 2 weeks
What are the investigations for h.pylori? (4)
• Stool antigen test
• Urea breath test using radiolabelled carbon 13
• H. pylori antibody test (blood)
• Rapid urease test performed during endoscopy (also known as the CLO test)
How does a rapid urease test work?
A rapid urease test involves taking a small biopsy of the stomach mucosa. This is added to a liquid medium containing urea. H. pylori produce urease enzymes that convert urea to ammonia. Ammonia makes the solution more alkaline. A pH indicator (e.g., phenol red) changes colour if the pH rises, giving a positive result.
What is h.pylori therapy?
Triple therapy
PPI plus 2 abx (amoxicillin and clarithromycin for 7 days
What is Zollinger-Ellison syndrome?
Zollinger-Ellison syndrome is a rare condition where a duodenal or pancreatic tumour secretes excessive quantities of gastrin. Gastrin is a hormone that stimulates acid secretion in the stomach. Therefore, there is excess production of stomach acid, resulting in severe dyspepsia, diarrhoea and peptic ulcers.
What are some features of Zollinger-Ellison syndrome?
Severe dyspepsia
Diarrhoea
Peptic ulcers
What are gastrin-secreting tumours associated with?
Men 1
What type of genetic condition is MEN1? E.g dominant / recessive
Autosomal dominant
