GORD Flashcards

1
Q

define GORD

A

chronic condition in whichh stomach contents flow back into the oesophagus, causing irritation to the mucosa
reflux is primary caused by an inappropriate, transient relaxtion of the lower eosophageal sphincter

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2
Q

endoscopic finding associated with GORD

A

reflux oesophagitis is associated with oesophageal mucosal injury
individuals may have classic GORD symptoms without eosophageal injury

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3
Q

NERD

A

non erosive reflux disease
50-70% of GORD patients
characteristic reflux disease in the absense of oesophageal injury such as reflux oesophagitis

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4
Q

transient lower oesophageal sphincter relaxations

A

normal - allow venting of accumulated gases to prevent distension of the stomach
in GORD, frequency of relaxtions increases andd two thirds of relaxations are accompanied by reflux of gastric content
this is thought to be due to delayed gastric emptying

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5
Q

imbalance between intragstric and lower oesophageal sphincter pressures

A

reflux occurs when the intragastric pressure in higher than that created by the lower oesophageal sphicter

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6
Q

lower oesophageal sphincter tone is decreased by

A

caffiene, nitroglycerin
conditions that cause denervation of the muscle layer, such as scleroderma

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7
Q

intragastric pressure is increased by

A

pregnancy, delayed gastric emptying and obesity

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8
Q

mechanisms of GORD

A

gastroeosophageal junction dysfunction caused by
- increased frequency of transient lower oesophageal sphincter relaxations
- imbalance between intragastric and lower oesophageal pshincter pressures
- anatomic abnormalities of the gastrooesophageal junction

and impaired oesophageal acid clearance

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9
Q

impaired oesophageal acid clearance

A

acid reflux should be neutralised by salivary bicarbonate and evacuated back to the stomach via oesophageal peristalsis
clearance may be disrupted by reduced salivation (eg. due to smoking) and/or decreased peristalsis eg. due to inflammation

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10
Q

why are smoking, caffiene and alcohhol risk factors

A

smoking, caffiene and alcohol - these all decrease LES tone
alcohol and caffiene also stiulte gastric acid secretion

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11
Q

why is pregnancy a risk factor for GORD

A

present in up to 80% of pregnancies
pathophysiology is due to increased abdominal pressure, decreased LES tone (due to high oestrogen and progesterone levels during pregnancy), and prolonged gastric emptying as a result of reduced gastric motility

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12
Q

the angle of His

A

the angle that is formed between the oesophagus and the gastric fundus
in healthy adults, it is 50-60º

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13
Q

why do children have more reflux than adults

A

infants usually have an underdeveloped, flat angle of His
regurgitation of stomach contents after meals is a common finding during the first 12 months of life and is not considered pathological

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14
Q

other risk factors for GORD

A

smoking, caffiene, and alcohol
stress
obesity
pregnancy
angle of His enlargement >60º
iatrogenic eg. after gastroscopy
inadequate oesophageal protective factors ie. saliva, peristalsis
gastrointestinal malformations and tumours
sclroderma
sliding hiatal hernia
asthma

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15
Q

typical symptoms of GORD

A

retrosternal burning pain
regurgitation
dyspagia, odynophagia
water brash

these symptoms can also be associated with oesophagitis or oesophageal cancer

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16
Q

water brash

A

a symptoms of excessive salivation triggered by refluxing of stomach acid

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17
Q

atypical symptoms of GORD

A

pressure sensation in the chest/noncardiac chest pain
belching/bloating
dyspepsia
nausea
halitosis

18
Q

halitosis

A

unpleaseant odour to breath

19
Q

extraoesophageal symptoms of GORD

A

chronic non productive cough and nighttime cough
hoarseness
bronchospasm
dental erosion

20
Q

aggrevating factors

A

lying down after meals
cartain foods/beverages = dependant on the individual

21
Q

red flags in GORD

A

dysphagia, odynophagia - these patients should be evaluated for eosophagitis and oesophageal cancer
anaemia and/or evidence of GI bleeding
unintentional weight loss
vomiting
signs of GI bleeding
presence of >1 risk factor for barretts oesophagus

22
Q

oesophagitis

A
  • infectious oesophigits
  • drug induced oesophigitis
  • eosinophilic eosophigitis
23
Q

gold standard test for GORD

A

there is no gold standard test for diagnosis
diagnosis is based on clinical presentation, endoscopic evaluation, reflux assessment and therapuetic response

24
Q

appoach for typical symptoms without red flags in GORD

A

initiate treatment with empiric one daily PPI trial
if there is relief after 8 weeks, GORD is likley, you can discontinue the PPI
if symptoms persist on PPI or recur after discontinuing PPi, refer for endoscopy

25
is testing fro H pylori required
not recommended in the workup of typical GORD in patients without dyspepsia in whom neither PUD nor gastritis is suspected
26
approach for red flags in GORD
refer to gastroenterology for endoscopy before initiating treatment
27
risk factors for barretts
male european descent age >50 obese symptoms >5 years
28
indications for endoscopy
red flags in GORD risk factors for barretts no imporvement after PPI trial red flags for dyspepsia
29
supportive findings on endoscopy
typically in the lowest third of the oesophagus erythema, edema, friability erosions, mucosal breaks, ulcerations peptic strictures and rings salmon pink mucosa (suggestive of barrett oesophagus) proximal migration of the Z line
30
what is salmon pink mucosa suggestive
barrett oesophagus
31
what is needed to diagnose eosinophillic oesophagitis
eosophageal biopsy
32
eosophageal pH monitoring indications
refractory GORD symptoms despite PPI therapy confirmation of suspected NERD
33
when to use barium swallow
not routinely indicated for GORD bu can be considered if the main symptom is dysphagia or if there is suspicion of structural abnormalitiies eg. oesophageal rings or webs or motility disorders
34
when to use eosophageal manometry
consider is achalasia or oesopageal hypermotility is suspected
35
oeosphageal manometry
a diagnostic test that is used to evaluate the peristaltic functuon of the oesophagus during swallowing the propagation, speed and vigor are the peristaltic wave is measured via an oesophageal catheter fitted with pressure sensors every 3-6cm may be used to investigated dysphasia due to oesophageal motility disorders
36
pharmacological therapy
PPIs - once daily 30-60 minutes before a meal H2 receptor antagonists
37
dietary recommendations
small portions avoid eatiing at least 2-3 hours before bed time avoid foods and beverages that appear to trigger symptoms
38
lifestyle recommendations
weight loss in patients with obesity elevate the head of the bed 10-20cm for patients with nighttime symptoms
39
medications that may worsen symtopms
calcium channel blockers diazepam
40
surgical therapy
should only be considered in select cases eg. patients wo develop complications despite recieving optimal medical therapy
41