GORD

Question 1

What is GORD?

Answer 1

where acid from the stomach flows through the lower oesophageal sphincter and into the oesophagus where it irritates the lining and causes heartburn symptoms

Question 2

What is the cardinal clinical presentation of GORD?

Answer 2

heartburn

Question 3

What cells line the oesophagus?

Answer 3

squamous epithelium

Question 4

What cells line the stomach?

Answer 4

columnar epithelium

Question 5

Describe the pathophysiology of GORD:

Answer 5

transient lower oesophageal sphincter relaxations (which occur as part of normal physiology) occur more frequently causing gastric flow back into the oesophagus

Question 6

Give 9 risk factors for GORD:

Answer 6

1) pregnancy
2) obesity
3) cigarette smoking
4) alcohol
5) coffee intake
6) large or fatty meals
7) spicy food intake
8) hiatus hernias
9) stress

Question 7

Give 3 drugs that predispose to GORD:

Answer 7

1) antimuscarinics
2) calcium-channel blockers
3) nitrates

Question 8

Give 6 clinical features of GORD:

Answer 8

1) heartburn (which is worse when bending, stooping or lying down)
2) acid regurgitation
3) bloating
4) nocturnal cough
5) hoarse voice
6) retrosternal/epigastric pain

Question 9

True or false: GORD is mostly a clinical diagnosis that doesn’t require further investigation

Answer 9

true

Question 10

Name two investigations for GORD:

Answer 10

1) endoscopy
2) intraluminal monitoring

Question 11

How can endoscopy help diagnose GORD?

Answer 11

it can visualise visible breaks in the oesophagus mucosa, indicating oesophagitis

Question 12

Describe how intraluminal monitoring can be used to investigate GORD:

Answer 12

a nasogastric tube with a pH probe is passed down the oesophagus for 24 hours

Question 13

What action is taken if a GORD patient has any red flags, particularly dysphagia?

Answer 13

2 week wait referral for direct access endoscopy

Question 14

What is the key red flag in GORD?

Answer 14

dysphagia

Question 15

Name 8 red flags associated with GORD:

Answer 15

1) dysphagia
2) weight loss
3) abdominal mass
4) resistant to treatment
5) upper abdominal pain
6) nausea and vomiting
7) raised platelet count
8) anaemia

Question 16

Name 3 lifestyle changes used to manage GORD:

Answer 16

1) weight loss
2) raising the head of the bed at night
3) reduction in alcohol and coffee consumption

Question 17

What medication may exacerbate gastritis/ GORD symptoms?

Answer 17

NSAIDs

Question 18

Give 3 examples of over the counter antacids:

Answer 18

1) Gaviscon
2) pepto-bismol
3) rennie

Question 19

What compound found in antacids reduces reflux?

Answer 19

alginate

Question 20

Give two examples of proton pump inhibitors:

Answer 20

1) omeprazole
2) lansoprazole

Question 21

Describe how PPIs reduce reflux symptoms:

Answer 21

they inhibit gastric H+/K+ ATPase, reducing gastric acid secretion

Question 22

Give 4 examples of histamine H2-receptor antagonists:

Answer 22

1) famotidine
2) ranitidine
3) cimetidine
4) nizatidine

Question 23

When are histamine H2-receptor antagonists used in the treatment of GORD?

Answer 23

1) if antacid use is unsuccessful
2) used with PPIs for patients with more severe GORD

Question 24

How do histamine H2-receptor antagonists relieve reflux symptoms?

Answer 24

they block the action of histamine on parietal cells in the stomach, decreasing production of gastric acid

Question 25

Name the surgical intervention used to treat GORD:

Answer 25

laparoscopic fundoplication

Question 26

Describe laparoscopic fundoplication:

Answer 26

tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter

Question 27

Which bacterial should be ruled out when investigating GORD?

Answer 27

H. pylori

Question 28

Name 3 investigations for H. pylori infection:

Answer 28

1) stool antigen test 2) urea breath test (radio labelled carbon-13) 3) rapid urease test

Question 29

What compound does H. pylori produce that allows it to neutralise stomach acid?

Answer 29

ammonium hydroxide

Question 30

What 3 drugs are used in H. pylori triple therapy?

Answer 30

1) PPI 2) two antibiotics (amoxicillin and clarithromycin)

Question 31

What is Barrett's oesophagus?

Answer 31

where the lower oesophageal epithelium changes from squamous to columnar epithelium via metaplasia caused by chronic acid reflux

Question 32

Name the premalignant condition caused by chronic reflux and is a leading risk factor for oesophageal adenocarcinoma:

Answer 32

Barrett's oesophagus

Question 33

What endoscopy finding indicates Barrett's oesophagus?

Answer 33

proximal displacement of the sqaumocolumnar mucosal junction

Question 34

What biopsy finding indicates Barrett's oesophagus?

Answer 34

columnar epithelium in the oesophagus

Question 35

What are the two main investigations for Barrett's oesophagus?

Answer 35

1) endoscopy 2) biopsy and histology

Question 36

Give 3 treatments for Barrett's oesophagus:

Answer 36

1) endoscopic monitoring for progression to adenocarcinoma 2) PPIs 3) endoscopic ablation

Question 37

Describe how endoscopic ablation treats Barrett's oesophagus:

Answer 37

it destroys columnar epithelial cells which are then replaced with normal squamous epithelial cells

Question 38

What is the name of the rare condition characterised by neuroendocrine tumours producing excessive gastrin?

Answer 38

Zollinger-Ellison Syndrome

Question 39

What is Zollinger-Ellison Syndrome?

Answer 39

a rare condition where a duodenal or pancreatic neuroendocrine tumour produces excessive gastrin which stimulates acid secretion in the stomach, resulting in severe dyspepsia

Question 40

What genetic condition is associated with Zollinger-Ellison Syndrome?

Answer 40

multiple endocrine neoplasia type 1 (MEN1)

Question 41

Is MEN1 an autosomal dominant or recessive condition?

Answer 41

autosomal dominant

Question 42

What is multiple endocrine neoplasia?

Answer 42

an autosomal condition characterised by endocrine tumours, particularly of the pancreas, parathyroid glands, duodenum and pituitary gland