GORD

Question 1

What is the prevalence of acid reflux?

Answer 1

40% of population monthly and 7% daily

Question 2

What are H2 receptor antagonists?

Answer 2

H₂ antagonists, sometimes referred to as H2RA and also called H₂ blockers, are a class of medications that block the action of histamine at the histamine H₂ receptors of the parietal cells in the stomach. => reduced HCl secretion.

Question 3

What the 3 main causes of GORD?

Answer 3

1) Incompetent lower oesophageal sphincter
2) Poor oesophageal clearance (narrowing in oesophagus?)
3) Barrier function/visceral sensitivity

Question 4

What are the symptoms of GORD?

Answer 4

Heartburn
Acid reflux
Waterbrash
Dysphagia
Odynophagia
Weight loss
Chest pain
Hoarseness
Coughing

Question 5

What is Odynophagia?

Answer 5

Pain on swallowing

Question 6

What is waterbrash?

Answer 6

regurgitation of an excessive accumulation of saliva from the lower part of the esophagus often with some acid material from the stomach.

Question 7

What investigations may be considered for a patient with the symptoms of GORD?

Answer 7

Endoscopy
Barium swallow
Oesophageal manometry and pH studies
Nuclear studies

Question 8

What is an oesophageal manometry?

Answer 8

Oesophageal manometry (also called oesophageal motility) is a procedure that is used to measure the strength and function of your oesophagus and provides information about how the muscles in your throat and oesophagus work as food and liquids pass from the mouth to the stomach.

Question 9

What is dyspepsia?

Answer 9

Indigestion

Question 10

What are the alarm symptoms associated with dyspepsia?

Answer 10

Dyphagia
Weightloss
Anaemia/pernicious anaemia
Barrett's oesophagus
Family history of upper GI cancer
PUD surgery 20 years ago
Vomiting

Question 11

What is pernicious anaemia?

Answer 11

a deficiency in the production of red blood cells through a lack of vitamin B12.

Question 12

WHo gets oesophageal carcinoma?

Answer 12

Men, obese, drink, smoke

Question 13

What is the treatment for oesophageal cancer?

Answer 13

Surgery, chemo, radio

Question 14

What is the 5 year survival for oesophageal adenocarcinoma?

Answer 14

5-10%

Question 15

Why is the incidence of adenocarcinoma in the oesophagus increasing and squamous cell carcinoma decreasing

Answer 15

Adenocarcinoma = obesity crisis
SSC = reduced smoking and drinking?

Question 16

What is the pathogenesis of oesophageal adenocarcinoma?

Answer 16

Normal
Oesophagitis (reflux oesophagitis)
Barrett’s oesophagus
Adenocarcinoma

Question 17

What is the management for GORD?

Answer 17

Symptom relief
Healing oesophagus
Prevention of complications

Question 18

How can patients modify their lifestyle to reduce GORD?

Answer 18

Stop smoking
Lose weight if obese
Prop up the bed head
Aviod provoking it (alcohol, large meals)

Question 19

What are the advantages and disadvantages of antacids?

Answer 19

+ Symptomatic relief
+ Well tolerated by most patients
- Do not aid healing of oesophagus or prevent complications

Question 20

Give some examples of antacids?

Answer 20

Rennies, Tums, Alcazelsa

Question 21

Give 2 examples of Histamine receptor antagonists?

Answer 21

Cimetidine and Ranitidine

Question 22

What are the advantages and disadvantages of Cimetidine?

Answer 22

+ Rapid symptom relief

- Can actually cause damage to oesophagus if used long term (less effective a healing than placebo)

Question 23

What are the advantages and disadvantages of Ranitidine?

Answer 23

• Tolerance after a month of therapy

- Poor at preventing relapse and complications

Question 24

What are the advantages and disadvantages of proton pump inhibitiors?

Answer 24

+ Very good symptom releif

+ Better at healing than histamine receptor antagonists

Question 25

Give 2 examples of PPIs?

Answer 25

Lansoprazole Omeprazole. Always consider the dose. 15mg of Lansoprazole produces similar effects to 30mg

Question 26

What surgery maybe considered in severe/unresponsive to medical management GORD?

Answer 26

Nissen Fundoplication

Question 27

What is Nissen Fundoplication?

Answer 27

laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease and hiatal hernia. Heals oesophagitis and controls symptoms in 70-90% of cases. It uses the top of the stomach to strengthen the sphincter so it is less likely to allow food, drink or acid to travel back into the foodpipe.

Question 28

When would Nissen Fundoplication surgery be considered for patients with GORD?

Answer 28

Young patients | Unresponsive to medical management

Question 29

How often soe Barrett's oesophagus occur in GORD patients?

Answer 29

10% of GORD patients

Question 30

What is Barrett's oesophagus?

Answer 30

Intestinal metaplasia due to chronic reflux oesophagitis. | Irreversible and increases risk of adenocarcinoma.

Question 31

How can dysplasia of the oesophagus be managed?

Answer 31

``` More frequent survelience- Endoscopy Optimise PPI dose Endoscopic mucosal resection- EMR Radiofrequency ablation (HALO) Argon ```

Question 32

What is endoscopic mucosal resection?

Answer 32

Endoscopic mucosal resection is a technique used to remove cancerous or other abnormal lesions found in the digestive tract

Question 33

How can argon be used to treat oesophageal dysplasia?

Answer 33

Argon plasma coagulation (APC) appears to be effective in the eradication of nondysplastic Barrett’s mucosa. APC is safe and effective in the management of HGD and in situ adenocarcinoma associated with Barrett's oesophagus.

Question 34

What are the 2 types of hiatus hernia?

Answer 34

Sliding hiatus hernia | Paraosophageal hiatus hernia

Question 35

What is gastroparesis?

Answer 35

Delayed gastric emptying but no physical obstruction in the lumen

Question 36

What are the symptoms of gastroparesis?

Answer 36

Feeling full Nausea and vomiting Weight loss Upper abdo pain

Question 37

What are the causes of gastroparesis?

Answer 37

``` Ideopathic Diabetes Cannabis Medication eg opites and anticholinergics Systemic diseases eg systemic sclerosis ```

Question 38

What is systemic sclerosis?

Answer 38

autoimmune disease of the connective tissue. It is characterized by thickening of the skin caused by accumulation of collagen, and by injuries to small arteries.

Question 39

What are the investigations for gastroparesis?

Answer 39

Gastric emptying studies

Question 40

How is gastroparesis managed?

Answer 40

Removal or precipitating factors eg drugs Liquid or soft diet Eat little and often Promotility agents

Question 41

What is achalasia?

Answer 41

Achalasia is a serious condition that affects your esophagus. The lower esophageal sphincter (LES) is a muscular ring that closes off the esophagus from the stomach. If you have achalasia, your LES fails to open up during swallowing, which it's supposed to do. This leads to a backup of food within your esophagus.