GORD

Question 1

What is GORD and how does it occur?

Answer 1

GORD is a condition where stomach acid flows through the lower oesophageal sphincter and into the oesophagus, causing irritation. The oesophagus, lined with squamous epithelium, is more sensitive to stomach acid compared to the stomach, which has a columnar epithelium that is better protected from acid.

Question 2

What factors can worsen the symptoms of GORD?

Answer 2

• Greasy and spicy foods
• Coffee and tea
• Alcohol
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Stress
• Smoking
• Obesity
• Hiatus hernia

Question 3

What are the common symptoms of GORD?

Answer 3

• Heartburn
• Acid regurgitation
• Retrosternal or epigastric pain
• Bloating
• Nocturnal cough
• Hoarse voice

Question 4

What red flag symptoms in GORD patients require urgent referral for endoscopy?

Answer 4

• Dysphagia (difficulty swallowing)
• Age over 55
• Weight loss
• Upper abdominal pain
• Reflux
• Treatment-resistant dyspepsia
• Nausea and vomiting
• Upper abdominal mass
• Low haemoglobin (anaemia)
• Raised platelet count

Question 5

What is oesophago-gastro-duodenoscopy (OGD) used for in GORD patients?

Answer 5

• Assessing gastritis
• Peptic ulcers
• Upper gastrointestinal bleeding
• Oesophageal varices
• Barrett’s oesophagus
• Oesophageal stricture
• Malignancy in the oesophagus or stomach

Question 6

What is a hiatus hernia and how does it contribute to GORD?

Answer 6

A hiatus hernia occurs when the stomach herniates up through the diaphragm, causing acid reflux. There are 4 types:
* Type 1 (Sliding): Stomach slides up through the diaphragm
* Type 2 (Rolling): Portion of the stomach folds around the diaphragm
* Type 3 (Combination): Both sliding and rolling hernia
* Type 4: Other organs, like the bowel or pancreas, enter the thorax through the hernia

Question 7

What are the treatment strategies for GORD?

Answer 7

• Lifestyle changes: Reduce tea, coffee, alcohol, weight loss, avoid smoking, smaller meals, avoid heavy meals before bedtime.
• Medications:
  
  • Antacids (short-term)
  • Proton pump inhibitors (e.g., omeprazole)
  • Histamine H2-receptor antagonists (e.g., famotidine)
• Surgery: Laparoscopic fundoplication (tightening the lower oesophageal sphincter).

Question 8

What role does Helicobacter pylori play in GORD and how is it tested?

Answer 8

H. pylori causes gastritis and ulcers and is tested in patients with dyspepsia. Testing requires 2 weeks of PPI cessation before testing. Tests include:
* Stool antigen test
* Urea breath test
* H. pylori antibody test
* Rapid urease test during endoscopy

Question 9

What is Barrett’s oesophagus and how is it managed?

Answer 9

Barrett’s oesophagus occurs when the lower oesophageal epithelium changes from squamous to columnar epithelium due to chronic acid reflux (metaplasia). It is a premalignant condition and increases the risk of oesophageal adenocarcinoma. Management includes:
* Endoscopic monitoring
* Proton pump inhibitors
* Endoscopic ablation (e.g., radiofrequency ablation) to reduce cancer risk.

Question 10

What is Zollinger-Ellison syndrome and what causes it?

Answer 10

Zollinger-Ellison syndrome is a rare condition where a pancreatic or duodenal tumour (gastrinoma) secretes excess gastrin, leading to overproduction of stomach acid. It can cause severe dyspepsia, diarrhoea, and peptic ulcers. It may be associated with multiple endocrine neoplasia type 1 (MEN1), an autosomal dominant condition causing other hormone-secreting tumours.