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GORD Flashcards

1
Q

What is GORD?

A

Dysfunctional relaxation of the Lower Oesophageal Sphincter (LOS), which cause the gastric acid contents to reflux into the oesophagus -> heartburn

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2
Q

What can GORD lead to?

A
  • Oesophagitis (inflammation of the oesophagus)
  • Ulcerations
  • Bleeding
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3
Q

GORD can cause what other problems?

A
  • Dental problems
  • Chronic asthma
  • Cough
  • Laryngitis
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4
Q

Is the LOS open or closed during relaxation?

A

Open

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5
Q

How is the gastric sphincter controlled?

A

By swallowing.

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6
Q

The gastric sphincter is controlled by which nervous control?

A
  • Electrical
  • Neurotransmitter
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7
Q

Acid is detected by what?

A

Chemoreceptors

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8
Q

What does the TLOSR stand for?

A

Transient Lower Oesophageal Sphincter Relaxations.

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9
Q

What does TLOSR cause?

A
  • Increased gastric pressure
  • Decreased clearance of refluxed material from oesophagus
  • Decreased oesophageal mucosal resistance
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10
Q

What enzyme can be refluxed into the oesophagus?

A

Pepsin

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11
Q

What are some symptoms of GORD?

A
  • Heartburn
  • Acid reflux
  • Upper abdominal discomfort
  • Bloating
  • Chest pain
  • Feeling full
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12
Q

What is an oesophageal spasm?

A

When the reflux of acid causes the oesophagus to spasm.

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13
Q

Which drugs directly irritate the gastric mucosa?

A
  • NSAIDS
  • Aspirin
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14
Q

What are the 3 groups of GORD?

A
  • Nonerosive reflux disease - reflux but no damage to cells in oesophagus
  • Erosive oesophagitis - inflammation of oesophagus and damage to cells
  • Barrett’s oesophagus - extensive damage -> cancer
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15
Q

During Barrett’s syndrome, when the lower oesophageal tissue is constantly damaged by acid, what happens to the cells?

A

The beginning of to resemble the epithelium cells in the stomach.

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16
Q

What are red flags symptoms of GORD?

A
  • Dysphagia
  • Bleeding
  • Unexplained weight loss
  • Choking
  • Chest pain
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17
Q

What is first done for the diagnosis of GORD?

A
  • Clinical symptoms and history
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18
Q

What is an empiric therapy?

A

A patient is put on a PPI for 4 weeks and then checked for improvement.

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19
Q

If any of the red flags are noticed, what should be done?

A

An endoscopy

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20
Q

What do we need to aim for in the therapy of GORD?

A
  • Relieve symptoms
  • Reduce recurrence and duration
  • Promote healing (mucosa)
  • Prevent complications/ syndromes
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21
Q

What are the therapy goals?

A
  • Increase LOS pressure
  • Increase oesophageal clearance
  • Improve gastric emptying
  • Protect oesophageal mucosa
  • Decrease acidity of reflux
  • Decrease gastric volume refluxed
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22
Q

What are the three phases in treatment?

A

Stage 1: Lifestyle modifications, therapy with OTCs
Stage 2: Pharmacological intervention
Stage 3: Surgical intervention

23
Q

What treatment is given in mild intermittent heartburn?

A
  • OTC antacids
  • OTC H2-receptor antagonists
  • OTC PPIs
24
Q

What treatment is given for symptomatic relief of mild to moderate GORD?

A
  • H2RAS
  • PPIs
25
What is the role of antacids?
Neutralise gastric acids
26
Which three products can antacids contain?
- Calcium - Magnesium - Aluminium
27
What are the 2 main products produced in the use of antacids?
- Water - Oxygen
28
Give an example of an antacid?
Rennie
29
True or False: The use of antacids promote oesophageal healing.
False
30
What is a side effect of using magnesium containing antacids?
Can be laxative.
31
What is a side effect of using an aluminium based antacid?
Can cause constipation
32
Give an example of an antacid.
Simeticone
33
What is the role of simeticone?
- Decrease the surface tension between gastrointestinal gas bubbles. - Acts as an antifoaming agent - Dispersal of antacid over gastric surface
34
What is another antacid?
Alginate
35
Give an example of alginate.
Gaviscon
36
What is some of the products which can be combined in alginates?
- Sodium alginate - Sodium bicarbonate - Calcium carbonate
37
In which stage of GORD is an alginate most effective in?
Nonerosive GORD
38
What are the 2 monomers in alginates?
- Guluronate - Mannuronate
39
What is the chemistry side of using an alginate?
- Carboxyl group interact with hydrochloric acid - Displaces Na+, changes conformation and drops out of solution
40
What happens during raft formation?
- Alginate interacts with Ca++ from calcium carbonate - Forms crosslinked alginate - Interacts with more Ca++ more crosslinked alginate
41
When taking alginates, what happens to the CO2?
Co2 is trapped in the alginate and floats to the top of the stomach
42
Give an example of a H2 Receptor Antagonist.
Cimetidine
43
When is cimetidine usually taken?
- At night for nocturnal symptoms - Before food which make cause reflux
44
What is the role of Histamine Receptor Antagonists?
Block histamine receptors in gastric parietal cells which prevent acid secretion
45
True or False: Histamine Receptor Antagonists aid healing of oesophageal damage.
True
46
Give 3 examples of Histamine Receptor Antagonists.
- Cimetidine - Famotidine - Nizatidine
47
What is the role of PPIs?
- Shut down proton pumps - Stop acid production in stomach cells - Prevent H+ going into stomach
48
Give 2 examples of PPIs.
- Esomeprazole (Nexium) - Pantoprazole
49
Give 3 conditions omeprazole can be used for.
- Heartburn - PUD - GORD
50
Which treatment is preferred, H2RAs or PPIs?
PPIs as they provide more of a relief of symptoms and faster healing.
51
What therapy is used for oesophageal mucosal resistance?
Alginates
52
Which therapy is used to antifoam/gas dispersal?
Simeticone
53
Which therapy is used for gastric acid?
- Antacids - H2RAs - PPIs

PHA223 (8 decks)

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