GORD

Question 1

def

Answer 1

gastro-oesphageal reflux disease

inflammation of oesphagus caused by reflux of gastric acid +/bile

Question 2

aetiology

Answer 2

disruption of mechanisms which prevent reflux
-physiological LOS
prolonged oesophageal clearance contributes to 50% of cases

Question 3

epi

Answer 3

common

prevelance 5-10% in adults

Question 4

history

Answer 4

burning pain beneath the sternum
aggravated by lying supine, bending, large meals, alcohol
relieved by antacids
aspiration may result in hoarseness, nocturnal cough + wheeze
dysphagia by peptic stricture with chronic reflux

Question 5

what is a rare complication of GORD

Answer 5

pneumonia

Question 6

examination

Answer 6

often normal
occasionally
-epigastric tenderness
-wheeze
-difficulty speaking

Question 7

investigations

Answer 7

in all patients > 45yrs, upper GI endoscopy, biopsy + cytological brushings

• confirm oesophagitis
• exclude malignancy

1 barium swallow to detect
-hiatus hernia
-peptic stricture
2 CXR
3 24H oesophageal monitoring
-determines temporal relationship between symptoms + oesophageal pH
-pain with lower oesphageal pH

Question 8

management

Answer 8

1 advice
-weight loss
-elevating head of bed
-stop smoking + alcohol
-avoid fatty meals
-avoid large meals in evening
2 medical
-antacids + alginates
-H2 antagonists (rantidine)
-PPIs (lansoprazole)
3 endoscopy
-yearly monitoring for barrett's oesophagus
4 surgery
-antireflux surgery for failed medical management
5 nissen fundoplication
-fundus of stomach wrapped around lower oesophagus
-reduces hiatus hernia
-reduces reflux

Question 9

complications

Answer 9

oesophageal ulceration
barrett’s oesphagus
oesophageal carcinoma
can exacerbate asthma

Question 10

prognosis

Answer 10

50% respond to lifestyle changes alone

patients who require drug therapy withdrawal often relapse

Question 11

what is barrett’s oesophagus

Answer 11

metaplasia of oesphageal squamous epithelium and replacement with columnar epithelium
a premalignant condition
increases risk of dysplasia + adenocarcinoma