GORD

Question 1

What 3 things stimulate parietal cells to secrete acid?

Answer 1

1. Histamine
2. ACh - vagus n.
3. Gastrin

Question 2

What symptoms are associated with GORD?

Answer 2

Dyspepsia
Heart burn
Acid taste
N+V

Question 3

What are the defences of the stomach?

Answer 3

Tight epithelial junctions
High cell turnover
High mucosal blood flow
Bicarbonate mucus

Question 4

What is the MOA of PPIs?

Answer 4

Binds to and causes destruction of PPI on apical membrane. Complete suppression of acid secretion.

Question 5

What are the side effects of PPIs?

Answer 5

Osteoporosis - increased pH, decreased Ca absorbed
Diarrhoea
Infection risk - C.difficile risk

Question 6

Give an example of a H2 antagonist.

Answer 6

Ranitidine

Question 7

What are the side effects of Ranitidine?

Answer 7

Males - gynaecomastia

Question 8

What tests are used for H.pylori?

Answer 8

Carbon 13 urea breathe test

Stool antigen test

Question 9

What is the treatment for H.Pylori?

Answer 9

Triple therapy - 2 antibiotics and 1 PPI for 1 week

Question 10

What are the issue with H.Pylori treatment?

Answer 10

Low adherence:
Lots of tablets to take
Diarrhoea side effects

Question 11

What are some causes of GORD?

Answer 11

LOS problems
Delayed gastric emptying
Hiatus hernia
Obesity - raised intra-abdo pressure

Question 12

Outline the approach a GP might take when treating GORD.

Answer 12

Step up.

1. Lifestyle
2. • antacids or alginates
3. H2 antagonist
4. PPI - only if necessary, osteoporosis

Question 13

What lifestyle changes could reduce GORD?

Answer 13

Weight loss
lower alcohol intake
smaller meals
less acidic foods
sleep propped up

Question 14

What red flag symptoms would you be looking out for?

Answer 14

Malaena
Weight loss
Mass
> 55
If persists after PPI then refer for endoscopy

Question 15

What are complications of GORD?

Answer 15

Barretts oesophagus
Cancer
Strictures

Question 16

What approach would a hospital doctor take when treating GORD and why?

Answer 16

Step down- patient at high risk of complications 
H.pylori test, stop aggravating drugs.
1. PPI
2. H2A
3. Antacid/alginate
4. Lifestyle
Patient at high risk of complications 
Lifelong H2A usually.

Question 17

What is the treatment for peptic ulcer?

Answer 17

1. Stop NSAIDs if possible
2. H2RA/PPI for 6 weeks - ulcer should heal unless malignancy.
3. H.pylori eradication
4. Biopsy