GORD Flashcards
3 mechanisms of GORD?
Transient LOS relaxation MC
LOS hypotension
Diaphragmatic hiatus hernia
What is GORD? Natural history?
Chronic regurgitation of gastric contents into oesophagus
Can cause oesophageal damage -> meta plasma from squamous to columnar epithelium (Barrett’s oesophagus - premalignant)
What can cause the inadequate clearing of refluxed gastric juice?
Decreased oesophageal peristalsis
Decreased salivation
What drugs can worsen reflux and what mechanism?
Reduced LOS tone via: Anti cholinergic Ca channel blocker NSAID Bisphosphonates
RF?
Increased intra-abdominal pressure I.e. Obesity, pregnancy
Gastric hyper secretion e.g Zollinger Ellison
How does GORD present?
Heartburn, acid regurg
Dysphagja +- odynophagia
Chest pain
Red flags for GORD?
Wt loss/fatigue/anorexia
Dysphagia/odynophagia
Extra-oesophageal manifestations?
Chronic cough
Asthma
Laryngitis
Dental erosions
What indications for endoscopy?
Red flags
Diagnostic uncertainty
Longstanding/refractory symptoms
Detection of Barrett’s
Non pharm management?
Avoid foods that decrease LOS tone e.g. Fatty foods, alcohol
Avoid acid foods
Lifestyle - weight loss, elevate head of bed at night
Pharmacological treatment?
PPI 4-8 weeks (30 minutes before food)
Maintenance PPI (lowest dose possible to reduce symptoms)
Withdraw PPI or H2-antagonists (use as on demand)
“STEP DOWN APPROACH”
Significance of Barrett’s? What screening?
20X risk of adenocarcinoma
If no dysplasia -> 5yr endoscopy
If dysplasia -> 3-6 month endo
High grade dysplasia -> intensive endoscopic surveillance/oesophagextomy/radiofreq ablation
How do you classify the causes of dysphagia?
Mechanical
- intraluminal: cancer, stricture, web
- extraluminal: external compression e.g. Lymph nodes, goitre
Motility
- achalasia
- MG
- scleroderma
- diffuse oesophageal spasm
