GORD

Question 1

What does GORD stand for?

Answer 1

Gastro-Oesophageal Reflux Disease

Question 2

What is GORD?

Answer 2

Gastric reflux into oesophagus due to decreased pressure across lower oesophageal sphincter causing oesophagitis

Question 3

What can cause GORD?

Answer 3

Increased intraabdominal pressure (pregnancy, obesity)

Hiatal hernia (lower oesophageal sphincter and part of stomach slides up through diaphragm)

Drugs (anti-muscarinics)

Scleroderma (lower oesophageal sphincter becomes scarred)

Question 4

How can an anti-muscarinic cause GORD?

Answer 4

Anti-cholinergic effects can change sphincter control leading to acid refluxing up through lower oesophageal sphincter into oesophagus

Question 5

What are symptoms of GORD?

Answer 5

Heartburn = retrosternal burning chest pain

Chronic cough

Nocturnal asthma (due to vagally mediated bronchoconstrictor reflexes)

Dysphagia (struggle swallowing as acid damages tissue leading to spasm or scarring and narrowing of lower oesophagus)

Question 6

When are symptoms normally worse in GORD?

Answer 6

At night/ when lying down as easier for acid to reflux

Question 7

How is GORD diagnosed?

Answer 7

Clinical diagnosis, ruling out red flags

Red flags include:
Dysphagia (difficulty swallowing)
Haematemesis
Weight loss

Endoscopy to check for oesophagitis or Barret’s oesophagus

Oesophageal manometry (catheter) to measure pressure and monitor gastric acid pH

Question 8

What is first line treatment for GORD?

Answer 8

Conservative:
Lifestyle changes like eating smaller meals at least 3 hours before bed

Question 9

What is second line treatment for GORD?

Answer 9

PPI
(if contraindicated then H2 receptor antagonist = H2RA)

Antacids
Alginates if symptomatic (creates a protective reflux barrier)

Question 10

What is a side effect of taking antacids?

Answer 10

Diarrhoea

Question 11

Name an alginate

Answer 11

Gaviscon

Question 12

What is last resort treatment for GORD?

Answer 12

Surgical tightening of LOS by Nissen Fundoplication

Fundus is wrapped around LOS externally to increase pressure across it

Question 13

Name 2 complications of GORD

Answer 13

Barrett’s oesophagus
Oesophageal strictures

Question 14

If oesophageal strictures develop, the patient is most commonly aged over __ and there is progressively worsening ______

Answer 14

60
dysphagia (struggle swallowing)

Question 15

What is treatment for oesophageal strictures?

Answer 15

Endoscopic oesophageal dilation and PPI

Question 16

What % of GORD patients develop Barret’s?

Answer 16

10%

Question 17

Barret’s always involves ____ _____

Answer 17

hiatal hernia

Question 18

What is called in Barrett’s when one cell type turns into another cell type?

Answer 18

Metaplasia

Question 19

Describe the metaplasia that occurs in Barrett’s oesophagus

Answer 19

Stratified squamous non-keratinising epithelium turns to simple columnar

Question 20

With the metaplasia in Barrett’s oesophagus there is an increased risk of _______

Answer 20

Adenocarcinoma

Question 21

The progression goes from normal oesophageal epithelium to metaplasia in ______ to d_____ and a_____

Answer 21

Barret’s
dysplasia
adenocarcinoma

Question 22

What is a typical patient who develops Barrett’s?

Answer 22

Middle aged Caucasian man with history of GORD and progressively worsening dysphagia

Question 23

How is Barret’s diagnosed?

Answer 23

Biopsy showing the metaplasia
(stratified squamous non-keratinising epithelium to simple squamous)