GORD Flashcards
What is GORD?
where acid from the stomach flows through the lower oesophageal sphincter and into the oesophagus where it irritates the lining and causes heartburn symptoms
What is the cardinal clinical presentation of GORD?
heartburn
What cells line the oesophagus?
squamous epithelium
What cells line the stomach?
columnar epithelium
Describe the pathophysiology of GORD:
transient lower oesophageal sphincter relaxations (which occur as part of normal physiology) occur more frequently causing gastric flow back into the oesophagus
Give 9 risk factors for GORD:
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
Give 3 drugs that predispose to GORD:
1) antimuscarinics
2) calcium-channel blockers
3) nitrates
Give 6 clinical features of GORD:
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
True or false: GORD is mostly a clinical diagnosis that doesn’t require further investigation
true
Name two investigations for GORD:
1) endoscopy
2) intraluminal monitoring
How can endoscopy help diagnose GORD?
it can visualise visible breaks in the oesophagus mucosa, indicating oesophagitis
Describe how intraluminal monitoring can be used to investigate GORD:
a nasogastric tube with a pH probe is passed down the oesophagus for 24 hours
What action is taken if a GORD patient has any red flags, particularly dysphagia?
2 week wait referral for direct access endoscopy
What is the key red flag in GORD?
dysphagia
Name 8 red flags associated with GORD:
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
Name 3 lifestyle changes used to manage GORD:
1) weight loss
2) raising the head of the bed at night
3) reduction in alcohol and coffee consumption
What medication may exacerbate gastritis/ GORD symptoms?
NSAIDs
Give 3 examples of over the counter antacids:
1) Gaviscon
2) pepto-bismol
3) rennie
What compound found in antacids reduces reflux?
alginate
Give two examples of proton pump inhibitors:
1) omeprazole
2) lansoprazole
Describe how PPIs reduce reflux symptoms:
they inhibit gastric H+/K+ ATPase, reducing gastric acid secretion
Give 4 examples of histamine H2-receptor antagonists:
1) famotidine
2) ranitidine
3) cimetidine
4) nizatidine
When are histamine H2-receptor antagonists used in the treatment of GORD?
1) if antacid use is unsuccessful
2) used with PPIs for patients with more severe GORD
How do histamine H2-receptor antagonists relieve reflux symptoms?
they block the action of histamine on parietal cells in the stomach, decreasing production of gastric acid
Name the surgical intervention used to treat GORD:
laparoscopic fundoplication
Describe laparoscopic fundoplication:
tying the fundus of the stomach around the lower oesophagus to narrow the lower oesophageal sphincter
Which bacterial should be ruled out when investigating GORD?
H. pylori
Name 3 investigations for H. pylori infection:
1) stool antigen test
2) urea breath test (radio labelled carbon-13)
3) rapid urease test
What compound does H. pylori produce that allows it to neutralise stomach acid?
ammonium hydroxide
What 3 drugs are used in H. pylori triple therapy?
1) PPI
2) two antibiotics (amoxicillin and clarithromycin)
What is Barrett’s oesophagus?
where the lower oesophageal epithelium changes from squamous to columnar epithelium via metaplasia caused by chronic acid reflux
Name the premalignant condition caused by chronic reflux and is a leading risk factor for oesophageal adenocarcinoma:
Barrett’s oesophagus
What endoscopy finding indicates Barrett’s oesophagus?
proximal displacement of the sqaumocolumnar mucosal junction
What biopsy finding indicates Barrett’s oesophagus?
columnar epithelium in the oesophagus
What are the two main investigations for Barrett’s oesophagus?
1) endoscopy
2) biopsy and histology
Give 3 treatments for Barrett’s oesophagus:
1) endoscopic monitoring for progression to adenocarcinoma
2) PPIs
3) endoscopic ablation
Describe how endoscopic ablation treats Barrett’s oesophagus:
it destroys columnar epithelial cells which are then replaced with normal squamous epithelial cells
What is the name of the rare condition characterised by neuroendocrine tumours producing excessive gastrin?
Zollinger-Ellison Syndrome
What is Zollinger-Ellison Syndrome?
a rare condition where a duodenal or pancreatic neuroendocrine tumour produces excessive gastrin which stimulates acid secretion in the stomach, resulting in severe dyspepsia
What genetic condition is associated with Zollinger-Ellison Syndrome?
multiple endocrine neoplasia type 1 (MEN1)
Is MEN1 an autosomal dominant or recessive condition?
autosomal dominant
What is multiple endocrine neoplasia?
an autosomal condition characterised by endocrine tumours, particularly of the pancreas, parathyroid glands, duodenum and pituitary gland
