GORD Flashcards
Pathophys GORD
- LOS controls passage of oesophagus contents into stomach
- Episodic relaxation is expected in normal function
- In GORD, these episodes become more frequent and allow reflux of contents into oesophagus
Problem with reflux
- Refluxed acidic contents = inflammation of oesophageal mucosa
- Hiatus hernia can increase reflux episodes - sphincter disturbed
RF GORD
- Obesity
- Smoking
- Alcohol intake
- Pregnancy
- Male gender
Symptom of GORD
- Chest pain - burning retrosternal sensation
- Worse after meals/lying down/bending over or straining
- Relieved by antacids
- Others inc belching, water brash sensation (sour taste), nocturnal/chronic cough
Red flag symptoms associated with GORD you should always check
- Dysphagia
- Weight loss
- Early satiety
- Malaise
- Loss of appetite
Classification of reflux
- Los Angeles classification - based on severity of endoscopic findings of mucosal breaks in distal oesophagus
Los Angeles classification of GORD
- Grade A - breaks 5mm or less
- B - more than 5mm
- C - extending between 2 or more mucosal folds but less than 75% circumference
- D - circumferential breaks 75% or more
Urgent referral criteria 2WW for suspected upper GI cancer
- Any patient with dysphagia
- Any patient >55yrs with weight loss and upper GI pain, dyspepsia or reflux
- Patients with persistent symptoms despote conservative management
Normal resolution of GORD
- Clinical diagnosis
- Trial of PPI settles symptoms
Gold standard diagnosis for GORD
24hr pH monitoring - can quantify burden of reflux and is important when medical treatment has failed and surgery is considered
Imaging for GORD - when and what
- If persistent or red flag symptoms patients often have upper GI endoscopy
- Rules out malignancy and assess for Barretts and hiatus hernia
- Oesophageal manometry if severe to exclude dysmotility of oesophagus
What is done with pH monitoring?
- Assess amount of time acid is present in oesophagus and correlation of presence and symptoms
- Produces algorithmic score called DeMeester score - determine symptom and reflux correlation
Conseravative management GORD
- Avoid precipitators - alcohol, coffee, fatty foods
- Weight loss
- Smoking cessation
Medical management GORD
- PPIs - long term usually
Indications for anti-reflux surgery
- Failure to respond or only partial response to medical therapy
- Patient preference - avoid life long medication
- Patients with complications of GORD - eg recurrent pneumonia
Surgery vs medical approach to GORD
- Surgery more effective - symptom relief, QOL improvement and cost
- BUT due to complications and side effects people are reluctant
Main surgical operation GORD
- Fundoplication - fundus wrapped around GOJ = recreation of lower oesophageal sphintcer
- Approaches differ in direction and completeness of wrap
Main side effects of anti-reflux surgery
- Dysphagia
- Bloating
these usually settle after few weeks post op
* No evidence to suggest reduces cancer risk from Barretts though
Complcations of GORD
- Aspiration pneumonia
- Barretts
- Oesophageal strictures
- Oesophageal cancer
- 0.1% risk adenocarcinoma if no endoscopy signs of strictures, Barretts metaplasia or adenocarcinoma
