GORD Flashcards
What is GORD?
Gastro-oesophageal reflux disease
Chronic condition of mucosal damage caused by stomach acid coming up from the stomach into the oesophagus
Is reflux of gastric contents into the oesophagus a normal event?
Yes, it only becomes a problem when there is prolonged contact of gastric contents on the oesophageal wall
How does gastro-oesophageal reflux occur?
Lower oesophageal sphincter tone is reduced
Delayed gastric emptying: increase in volume and pressure in the stomach, so the LOS valve is defeated
What increases the chance of getting GORD?
A hiatus hernia Obesity Pregnancy Systemic sclerosis Certain drugs
What is a hiatus hernia? Two types.
Sliding: when the gastro-oesophageal junction slides up into the chest above the diaphragm
Rolling: a bulge of the stomach slides up into the chest above the diaphragm, but the g-o junction remains below
What are the clinical features of GORD?
Heartburn
Regurgitation
Odynophagia (painful swallowing)
Belching
Cough and nocturnal asthma: from aspiration of gastric contents into lung
Laryngitis
What complications ca occur from GORD?
Oesophageal stricture formation
Barrett’s oesophagus: abnormal columnar epithelia irreversibly replaces the normal squamous epithelium
Oesophageal adenocarcinoma
Investigations for GORD?
Diagnose clinically from symptoms
Endoscopy only in certain cases
Barium swallow: show up hiatus hernia
When would you do an endoscopy in GORD?
If there is:
Vomiting GI bleeding Iron deficiency Palpable mass Age over 55 Dysphagia Symptoms despite treatment Weight loss
Treatment of GORD.
Lifestyle change: stop smoking, lose weight, raise bed head
Diet: don’t eat things that aggravate symptoms
Drugs: antacids, PPIs
Surgery: aims to strengthen lower oesophageal sphincter
What is a PPI?
Proton pump inhibitor
Inhibits pumping of H+ ions into stomach, reducing the pH
How do you diagnose Barrett’s oesophagus?
Endoscopy: affected area looks velvety
Biopsy: see columnar epithelium in place of squamous
What is so concerning about Barrett’s oesophagus?
It is premalignant, can lead to adenocarcinoma of the oesophagus
Management of Barrett’s oesophagus.
Surgery to remove damaged section of oesophagus
Mucosal ablation using laser or similar
Simply monitor the area to look for signs of malignancy
What is a Mallory-Weiss tear?
A tear in the mucosa of the oesophagus caused by persistent retching and vomiting
