GORD Flashcards
What does GORD stand for?
Gastro-Oesophageal Reflux Disease
What is GORD?
Gastric reflux into oesophagus due to decreased pressure across lower oesophageal sphincter causing oesophagitis
What can cause GORD?
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)
How can an anti-muscarinic cause GORD?
Anti-cholinergic effects can change sphincter control leading to acid refluxing up through lower oesophageal sphincter into oesophagus
What are symptoms of GORD?
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)
When are symptoms normally worse in GORD?
At night/ when lying down as easier for acid to reflux
How is GORD diagnosed?
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
What is first line treatment for GORD?
Conservative:
Lifestyle changes like eating smaller meals at least 3 hours before bed
What is second line treatment for GORD?
PPI
(if contraindicated then H2 receptor antagonist = H2RA)
Antacids
Alginates if symptomatic (creates a protective reflux barrier)
What is a side effect of taking antacids?
Diarrhoea
Name an alginate
Gaviscon
What is last resort treatment for GORD?
Surgical tightening of LOS by Nissen Fundoplication
Fundus is wrapped around LOS externally to increase pressure across it
Name 2 complications of GORD
Barrett’s oesophagus
Oesophageal strictures
If oesophageal strictures develop, the patient is most commonly aged over __ and there is progressively worsening ______
60
dysphagia (struggle swallowing)
What is treatment for oesophageal strictures?
Endoscopic oesophageal dilation and PPI
What % of GORD patients develop Barret’s?
10%
Barret’s always involves ____ _____
hiatal hernia
What is called in Barrett’s when one cell type turns into another cell type?
Metaplasia
Describe the metaplasia that occurs in Barrett’s oesophagus
Stratified squamous non-keratinising epithelium turns to simple columnar
With the metaplasia in Barrett’s oesophagus there is an increased risk of _______
Adenocarcinoma
The progression goes from normal oesophageal epithelium to metaplasia in ______ to d_____ and a_____
Barret’s
dysplasia
adenocarcinoma
What is a typical patient who develops Barrett’s?
Middle aged Caucasian man with history of GORD and progressively worsening dysphagia
How is Barret’s diagnosed?
Biopsy showing the metaplasia
(stratified squamous non-keratinising epithelium to simple squamous)
