GORD Flashcards
What can GORD lead to eventually?
Oesophagitis, strictures, Barrett’s oesophagus
Causes include? Name 5
Lower oesophageal hypotension, hiatus hernia, loss of oesophageal peristalsis, pregnancy, smoking, alcohol, overeating, obesity, muscle relaxing drugs eg CCBs, gastric acid hyper secretion, systemic sclerosis
Oesophageal symptoms including?
Heartburn, pain post meal and lying down/leaning forward, belching acid brash, water brash, ondynophagia
Extra oesophageal symptoms include?
Nocturnal asthma, chronic cough, laryngitis, sinusitis
Complications include?
Oesophagitis, benign stricture, iron deficiency, Barrett’s (metaplasia to dysplasia to neoplasia
What happens in Barrett’s?
Metaplasia, from squamous epithelial to columnar
What if the patient has dysplasia?
Low grade 90% will have an adenocarcinoma in 5yrs
High grade 50% already have an adenocarcinoma
What are the indications for endoscopy?
Symptoms persist >4 weeks, persistent vomiting, GI bleeding, iron deficiency, palpable mass, over 55yrs old, dysphasia, symptoms despite treatment, relapsing symptoms, loss of weight
If endoscopy is contraindicated what else might you do?
Barium swallow, may show hiatus hernia
If endoscopy is normal what test might help diagnosis?
24hr pH testing / manometry
Treatment
Lifestyle modifications (eg weight loss, smoking cessation), antacids, surgery
What conservative measures are advised? Name 3 things to do and 3 things to avoid
Raise head when lying, weight loss, smoking cessation, smaller more frequent meals
Avoid: hot drinks, alcohol, citrus fruits, fizzy drinks spicy foods, eating within 3 hours of bedtime, anti cholinergics, nitrates, CCBs
What surgery can be done for treatment resistant GORD?
Nissen Fundoplication
What grading system is used?
Los Angeles scoring system
What are the grades?
1: 1 mucosal break smaller than 5mm
2: 1 mucosal break greater than 5mm
3: continuos mucosal break covering less than 75% of circumference
4: continuos mucosal break covering more than 75% of circumference
