GORD Flashcards
What is the prevalence of acid reflux?
40% of population monthly and 7% daily
What are H2 receptor antagonists?
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.
What the 3 main causes of GORD?
1) Incompetent lower oesophageal sphincter
2) Poor oesophageal clearance (narrowing in oesophagus?)
3) Barrier function/visceral sensitivity
What are the symptoms of GORD?
Heartburn Acid reflux Waterbrash Dysphagia Odynophagia Weight loss Chest pain Hoarseness Coughing
What is Odynophagia?
Pain on swallowing
What is waterbrash?
regurgitation of an excessive accumulation of saliva from the lower part of the esophagus often with some acid material from the stomach.
What investigations may be considered for a patient with the symptoms of GORD?
Endoscopy
Barium swallow
Oesophageal manometry and pH studies
Nuclear studies
What is an oesophageal manometry?
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.
What is dyspepsia?
Indigestion
What are the alarm symptoms associated with dyspepsia?
Dyphagia Weightloss Anaemia/pernicious anaemia Barrett's oesophagus Family history of upper GI cancer PUD surgery 20 years ago Vomiting
What is pernicious anaemia?
a deficiency in the production of red blood cells through a lack of vitamin B12.
WHo gets oesophageal carcinoma?
Men, obese, drink, smoke
What is the treatment for oesophageal cancer?
Surgery, chemo, radio
What is the 5 year survival for oesophageal adenocarcinoma?
5-10%
Why is the incidence of adenocarcinoma in the oesophagus increasing and squamous cell carcinoma decreasing
Adenocarcinoma = obesity crisis SSC = reduced smoking and drinking?
What is the pathogenesis of oesophageal adenocarcinoma?
Normal
Oesophagitis (reflux oesophagitis)
Barrett’s oesophagus
Adenocarcinoma
What is the management for GORD?
Symptom relief
Healing oesophagus
Prevention of complications
How can patients modify their lifestyle to reduce GORD?
Stop smoking
Lose weight if obese
Prop up the bed head
Aviod provoking it (alcohol, large meals)
What are the advantages and disadvantages of antacids?
+ Symptomatic relief
+ Well tolerated by most patients
- Do not aid healing of oesophagus or prevent complications
Give some examples of antacids?
Rennies, Tums, Alcazelsa
Give 2 examples of Histamine receptor antagonists?
Cimetidine and Ranitidine
What are the advantages and disadvantages of Cimetidine?
+ Rapid symptom relief
- Can actually cause damage to oesophagus if used long term (less effective a healing than placebo)
What are the advantages and disadvantages of Ranitidine?
- Tolerance after a month of therapy
- Poor at preventing relapse and complications
What are the advantages and disadvantages of proton pump inhibitiors?
+ Very good symptom releif
+ Better at healing than histamine receptor antagonists
Give 2 examples of PPIs?
Lansoprazole
Omeprazole.
Always consider the dose. 15mg of Lansoprazole produces similar effects to 30mg
What surgery maybe considered in severe/unresponsive to medical management GORD?
Nissen Fundoplication
What is Nissen Fundoplication?
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.
When would Nissen Fundoplication surgery be considered for patients with GORD?
Young patients
Unresponsive to medical management
How often soe Barrett’s oesophagus occur in GORD patients?
10% of GORD patients
What is Barrett’s oesophagus?
Intestinal metaplasia due to chronic reflux oesophagitis.
Irreversible and increases risk of adenocarcinoma.
How can dysplasia of the oesophagus be managed?
More frequent survelience- Endoscopy Optimise PPI dose Endoscopic mucosal resection- EMR Radiofrequency ablation (HALO) Argon
What is endoscopic mucosal resection?
Endoscopic mucosal resection is a technique used to remove cancerous or other abnormal lesions found in the digestive tract
How can argon be used to treat oesophageal dysplasia?
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.
What are the 2 types of hiatus hernia?
Sliding hiatus hernia
Paraosophageal hiatus hernia
What is gastroparesis?
Delayed gastric emptying but no physical obstruction in the lumen
What are the symptoms of gastroparesis?
Feeling full
Nausea and vomiting
Weight loss
Upper abdo pain
What are the causes of gastroparesis?
Ideopathic Diabetes Cannabis Medication eg opites and anticholinergics Systemic diseases eg systemic sclerosis
What is systemic sclerosis?
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.
What are the investigations for gastroparesis?
Gastric emptying studies
How is gastroparesis managed?
Removal or precipitating factors eg drugs
Liquid or soft diet
Eat little and often
Promotility agents
What is achalasia?
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.
