GORD (2) Flashcards
What is it?
How does this affect the oesophagus over time?
What are its risk factors?
What are its differentials?
➊ Reflux of gastric contents, through a defective LOS, into the oesophagus, causing inflammation (= Reflux Oesophagitis)
➋ Squamous → Columnar epithelium as a protective mechanism
➌ • Hiatus hernia - weakens LOS
• Smoking, Alcohol, Coffee - decreases LOS tone
• Obesity, Pregnancy - increases intra-abdominal pressure
• Intake of specific foods e.g. citrus foods, spicy foods, fat
➍ PUD, Oesophageal ca., Oesophageal spasm, Angina
What’s its typical presenting symptom?
What are its atypical symptoms?
➊ Heartburn - worse on eating, lying down or bending over
➋ • Belching
• Chronic cough
• Bloating
• Acid brash - acid in throat causes increased salivation
• Odynophagia - painful swallow due to oesophagitis/ulcerations
• Hoarse voice
• Tooth erosion
How can it investigated?
What are the lifestyle changes to be made?
How is it managed medically?
What’s the last option in managing it?
➊ Mainly a clinical diagnosis, but to aid the diagnosis you can:
• Trial standard-dose PPI
• OGD if alarming features or atypical, persistent or relapsing symptoms
• Oesophageal manometry to assess LOS competence
➋ • Weight loss
• Small/Lighter meals
• Avoid eating late at night (3+ hrs)
• Sleep on left side
• Less alcohol and coffee
➌ • PPI
• Antacids
• H2 receptor antagonist (Antihistamine) e.g. Ranitidine - Alternative to PPI and reduces stomach acid
➍ Laparoscopic Fundoplication
What are its complications?
• Barrett’s Oesophagus
• Oesophageal ulcer
• Bleeding - Presents as haematemesis/melaena
• Stricture - Presents as progressive dysphagia
• Oesophageal ca.
