GORD

Question 1

What is GORD?

Answer 1

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.

Question 2

What cells line the stomach?

Answer 2

Columnar epithelial cells

Question 3

What factors exacerbate GORD? (8)

Answer 3

• Greasy and spicy foods
• Coffee and tea
• Alcohol
• Non-steroidal anti-inflammatory drugs
• Stress
• Smoking
• Obesity
• Hiatus hernia

Question 4

What is the presentation of GORD?

Answer 4

Dyspepsia

Question 5

What symptoms does dyspepsia cover? (6)

Answer 5

○ Heartburn
○ Acid regurgitation
○ Retrosternal or epigastric pain
○ Bloating
○ Nocturnal cough
○ Hoarse voice

Question 6

What are the key red flag features in GORD? (10)

Answer 6

• 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

Question 7

What is a hiatus hernia?

Answer 7

herniation of the stomach up through the diaphragm

Question 8

What are the 4 types of hiatus hernia?

Answer 8

• Type 1: Sliding
• Type 2: Rolling
• Type 3: Combination of sliding and rolling
• Type 4: Large opening with additional abdominal organs entering the thorax

Question 9

What is a type 1 hiatus hernia?

Answer 9

A sliding hiatus hernia is where the stomach slides up through the diaphragm, with the gastro-oesophageal junction passing up into the thorax.

Question 10

What is a type 2 hiatus hernia?

Answer 10

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.

Question 11

What is a type 4 hiatus hernia?

Answer 11

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).

Question 12

Why might a hiatus hernia not be seen on imaging?

Answer 12

They can be intermittent

Question 13

What imaging can show a hiatus hernia? (4)

Answer 13

○ Chest x-ray
○ CT scan
○ Endoscopy
○ Barium swallow test

Question 14

What lifestyle changes are given in GORD? (6)

Answer 14

○ 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

Question 15

What are the management of GORD? (6)

Answer 15

• 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

Question 16

What is the surgery for GORD?

Answer 16

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.

Question 17

What type of bacteria h.pylori?

Answer 17

Gram negative aerobic bacteria

Question 18

How does h.pylori damage the stomach?

Answer 18

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.

Question 19

What does h.pylori produce?

Answer 19

Ammonium hydroxide which neutralises the acid surrounding the bacteria
Toxins

Question 20

What should be done before testing for h.pylori?

Answer 20

Stop taking PPIs for 2 weeks

Question 21

What are the investigations for h.pylori? (4)

Answer 21

• 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)

Question 22

How does a rapid urease test work?

Answer 22

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.

Question 23

What is h.pylori therapy?

Answer 23

Triple therapy
PPI plus 2 abx (amoxicillin and clarithromycin for 7 days

Question 24

What is Zollinger-Ellison syndrome?

Answer 24

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.

Question 25

What are some features of Zollinger-Ellison syndrome?

Answer 25

Severe dyspepsia
Diarrhoea
Peptic ulcers

Question 26

What are gastrin-secreting tumours associated with?

Answer 26

Men 1

Question 27

What type of genetic condition is MEN1? E.g dominant / recessive

Answer 27

Autosomal dominant