GORD Flashcards
Reflux of gastric contents into the oesophagus is normal
GORD is said to occur when this causes symptoms.
What may prolonged/ excessive reflux cause?
Oesophagitis
Benign oesophageal strictures
Barret’s oesophagus
Causes of GORD?
Lower oesophageal sphincter hypertension
Hiatus hernia (stomach squeezes into thorax via diaphragm hiatus)
Abdominal obesity
Gastric acid hyper-secretion
Slow gastric emptying
Risk factors for GORD
Overeating Smoking Alcohol Pregnancy Surgery on oesophagus Drugs: tricyclic antidepressant, anticholinergics, nitrates
Describe pathophysiology of GORD?
Lower oesophageal sphincter (LOS) tone is reduced, and there are frequent transient LOS relaxations
Increased mucosal sensitivity to gastric acid
Reduced oesophageal clearance of acid
Delayed gastric emptying and prolonged post-prandial and nocturnal reflux also contribute
What oesophageal symptoms present clinically?
Heartburn – burning, retrosternal discomfort after meals, lying, stooping or straining, relieved by antacids
Belching
Acid brash
Water brash
Odynophagia- painful swallowing (due to ulceration or oesophagitis)
What extra oesophageal symptoms present clinically
Nocturnal asthma
Chronic cough
Sinusitis
Laryngitis (hoarseness and throat clearing)
Complications of GORD?
Oesophagitis Ulcers Benign stricture Iron deficiency Metaplasia—> dysplasia—> neoplasia
Differential Diagnosis of GORD
Oesophagitis from corrosives, NSAIDs, herpes, Candida
Duodenal or gastric ulcers/ cancers
Non-ulcer dyspepsia
Sphincter of Oddi (in ampulla of Vater) malfunction
Cardiac disease
Diagnostic tests and results
Mostly clinical
Endoscopy if alarm signs for upper GI malignancy
Barium swallow may show hiatus hernia
24 hour oesophageal ph monitoring will help diagnose GORD if endoscopy is normal
What lifestyle changes are advised as management for GORD?
Weight loss Avoid excess alcohol/ aggrevating food Smoking cessation raising bed head Small meals
What medical treatment is given to patients with GORD?
Alginates- form a foam raft on gastric contents
Antacids
PPIs
H2- receptor antagonists
PPIs inhibit gastric H+/K+-ATPase, blocking luminal secretion of gastric acid
Name 2
lansoprazole, omeprazole
Name a H2 receptor antagonist
Ranitidine
How do antacids work?
Contain alkaline ions
What surgical options are available in severe GORD
laparoscopic (key hole)
Aims to increase resting pressure in lower oesophageal sphincter
