GORD

Question 1

What is GORD

Answer 1

Gastric-oesophageal reflux disease = reflux of gastric contents into oesophagus due to decreased pressure across lower oesophageal sphincter

Question 2

Causes of GORD (4)

Answer 2

• raised intragastric pressure= obesity + pregnancy
• hiatal hernia (mostly with LOS sliding up through diaphragm)
• Drugs anti-muscarinics, CCBs
• Scleroderma (LOS = scarred)

Question 3

Investigations to diagnose GORD (3)

Answer 3

If no red flags go straight to treatment (PPI)

Red flags (dysphagia, haematemesis, weight loss)
- endoscopy —> oesphagitis or Barrett’s
- oesophagal manometry —> measure functionality of LOS and gastric acid pH

Question 3

Symptoms of GORD (5)

Answer 3

“Heartburn”
-Retrosternal burning chest pain that is exacerbated by lying flat
-Sour/bitter taste of acid in the back of the mouth
-dysphagia
-nausea
-chronic cough

Question 4

Treatment for GORD (4)

Answer 4

-Conservative lifestyle changes (smaller meals, 3+hrs before bed, avoidance of trigger foods)

-medication review: consider reducing or stoppping medications that are causing symptoms eg CCB

-PPI offer full dose for 1-2 months
If symptoms persists use PPI at lowest dose possible as maintenance

If symptoms still persist or CI then use H2 Receptor Antagonist

Question 5

Complications of GORD (3)

Answer 5

-Barrett’s oesophagus
-oesophageal stricture - fibrous scarring and therefore narrowing of oesophageal lumen
-dental problems

Question 5

Last resort for GORD treatment?

Answer 5

Surgical treatment- laparoscopic fundoplication = mobilisation of fundus of stomach which is then wrapped around the lower oesophageal sphincter to tighten it

Question 6

Tell me about Barrett’s oesophagus (association, metaplasia, diagnosis) (3)

Answer 6

-Always involves hiatal hernia
-Metaplasia (Stratified Squamous NKE —>simple columnar)
- Diagnose with biopsy