GORD

Question 1

What are the risk factors of GORD

Aetiology (6)

Answer 1

Obesity
Smoking
Diet
medication
Hiatus hernia
pregnancy

Question 2

How does a Hiatal Hernia occur?

Answer 2

A hiatal hernia occurs when part of the stomach protrudes through the diaphragm into the thoracic cavity, contributing to GERD.

Question 3

How does obesity contribute to the development of GERD?

Answer 3

Obesity increases abdominal pressure, which can push stomach contents up into the esophagus, overwhelming the lower esophageal sphincter and leading to reflux.

Question 4

Which mechanism is primarily responsible for the reflux of stomach contents into the esophagus in GERD?

Answer 4

Weakening of the lower esophageal sphincter (LES)

Question 5

What is Barrets Oesophagus?

Answer 5

The replacement of nromal esophagel squamous cells with columnar cells

Question 6

Explain the role of esophageal motility in the pathophysiology of GERD

Answer 6

Impaired esophageal motility can reduce the efficiency of esophageal peristalsis, which decreases the clearance of acid from the esophagus. This can contribute to prolonged exposure of the esophageal lining to acidic content, exacerbating GERD symptoms.

Question 7

Which class of medication is used to neutralize stomach acid in the treatment of GERD?

Answer 7

c) Antacids

Question 8

True or False: Proton pump inhibitors (PPIs) are considered a first-line treatment for GERD due to their ability to significantly reduce gastric acid production.

Answer 8

True

Question 9

Provide an example of an H2-receptor antagonist and explain its mechanism of action in GERD treatment.

Answer 9

An example of an H2-receptor antagonist is Famotidine. H2-receptor antagonists work by blocking histamine H2 receptors in the stomach lining, which reduces the production of gastric acid and helps to alleviate GERD symptoms.

Question 10

GORD red flag symptoms

Alarm (5)

Answer 10

Unintentional weight loss
dysphagia
Age >55
Anaemia
Hemetamesis / Malaena

Question 11

Persistent dysphagia (difficulty swallowing) in a GERD patient indicates what?

Answer 11

esophageal cancer or severe esophageal damage, or blockage in the oesophagus

Question 12

What are the potential implications of the presence of hematemesis (vomiting blood) in a patient with GERD?

Answer 12

Hematemesis in a patient with GERD suggests significant esophageal damage or bleeding, possibly due to esophageal ulcers. This requires immediate evaluation and treatment, including endoscopy, to identify the cause and manage any potential complications.

Question 13

Which 3 chemicals stimulate the production of gastric acid by stimulation of parietal cells?

Answer 13

gastrin
acetylcholine
histamine

Question 14

What effect does histamine have on proton pump activity?

Answer 14

b) Directly activates the proton pump through H₂ receptors

Question 15

A patient with GERD is experiencing severe symptoms despite being on an H₂-receptor antagonist. Explain why an H₂-receptor antagonist might be less effective compared to a proton pump inhibitor (PPI) in managing this condition.

Answer 15

H₂-receptor antagonists work by blocking histamine H₂ receptors, which reduces acid production by inhibiting the proton pump indirectly. However, PPIs provide a more effective reduction in gastric acid production because they directly inhibit the proton pump (H⁺/K⁺-ATPase), which is the final step in acid secretion. As a result, PPIs offer a more potent and sustained decrease in acid production compared to H₂-receptor antagonists, leading to better management of GERD symptoms.

Question 16

A 30-year-old male with a history of GERD is currently on a daily dose of ranitidine (an H₂-receptor antagonist) but reports persistent symptoms. He complains of ongoing heartburn and occasional regurgitation despite adhering to his medication regimen.

Question: What might be the reason for the inadequate response to ranitidine, and what alternative treatment options should be considered?

Answer 16

Inadequate response to ranitidine might be due to:

Insufficient Acid Suppression: H₂-receptor antagonists may not provide adequate acid suppression for some patients, especially if symptoms are severe or acid production is particularly high.
Alternative treatment options include:

Proton Pump Inhibitors (PPIs): PPIs are more effective than H₂-receptor antagonists in reducing gastric acid production and should be considered as an alternative.
Further Evaluation: If symptoms persist despite PPI therapy, further evaluation may be warranted to assess for possible complications or other underlying conditions.

Question 17

A 50-year-old woman with GERD reports that her symptoms are triggered by certain foods and beverages. She is unsure which dietary changes might be beneficial.

Question: What dietary and lifestyle modifications would you recommend to this patient to help manage her GERD symptoms?

Answer 17

• Avoiding Trigger Foods: Common triggers include spicy foods, fatty foods, chocolate, caffeine, and citrus fruits.
• Eating Smaller Meals: Encourage smaller, more - frequent meals rather than large meals.
• Avoiding Late-Night Eating: Advise against eating large meals or snacking close to bedtime.
• Elevating the Head of the Bed: Suggest raising the head of the bed by 6-8 inches to reduce nighttime reflux.
• Maintaining a Healthy Weight: Weight loss can help reduce abdominal pressure and GERD symptoms.

Question 18

dyspepsia

Answer 18

A symptom inetself - symptoms of heartburn/indigestion