GORD

Question 1

What are some lifestyle factors you can recommend for someone?

Answer 1

1) cutting down alcohol
2) lose weight
3) quit smoking
4) physical exercise
5) sleep on pillows, don’t lie down.
6) no eating 2-3 hours before exercise
7) smaller meals

Question 2

What are 3 Medications you can prescribe for GORD? Describe their mechanism of action?

Answer 2

1) Proton Pump inhibitors
- irreversibly inactive the H/K ATPase suppressing basal and stimulated acid.
2) H2 receptor antagonists
- blocks H2 receptors on parietal cells reducing gastric acid
3) antacids
- neutralise hydrochloric acid secreted, not good for long term

Question 3

What are the red flag symptoms for GORD?

Answer 3

ALARMS 
A - anaemia 
L - loss of weight 
A - anorexia 
R - recent onset of progressive symptoms 
M - maelena/haematemesis 
S - swallowing difficulties (dysphagia)

Question 4

What are some indications for Endoscopy?

Answer 4

1) red flag symptoms
2) new symptoms in older person
3) change in symptoms
4) severe/frequent symptom
5) inadequate treatment response
6) clarification on diagnosis

Question 5

Complications of GORD?

Answer 5

Oesophageal Stricture disease (dysphagia)

Ulcers, hemorrhage, perforation

Barrett’s oesophagus

Adenocarcinoma

Question 6

What is the pathophysiology of GORD?

Answer 6

• true sphincter dysfunction
  
  • hiatus hernia,
  • scleroderma
• oesophageal dysfunction
  
  • achalasia
• increased abdominal pressure
  
  • obesity/pregnancy
  • delayed gastric emptying
• injurious agent
  
  • gastric acid hyper secretion
  • drugs
  • H. Pylori