GORD

Question 1

What is the anatomical abnormality in GORD?

Answer 1

Lower oesophageal sphincter relaxes more frequently allowing the reflux of gastric contents.

This can cause pain and mucosal damage.

Question 2

What are risk factors for GORD?

Answer 2

Alcohol
Obestiy
Smoking
Caffienated drinks
Fatty or spicy foods

Question 3

What are the clinical features of GORD?

Answer 3

Chest pain
Burining retrosternal sensation
Worse after meals, lying down, bending over or straining.
Relieved by antacids

Belching
Odynophagia - pain on swallowing
Chronic nocturnal cough
Hoarseness

Question 4

What should you check for in a person with GORD?

Answer 4

Dysphagia, weight loss, early satiety, malaise, loss of appetite.

Underlying malignancy

Question 5

What are differentials for GORD?

Answer 5

Malignancy
Peptic ulceration
Oesophagitis
Cardiac disease
Biliary disease

Question 6

How is GORD diagnosed?

Answer 6

Clinical diagnosis and PPI trial

Question 7

What are red flags for upper GI malignancy?

Answer 7

Dysphagia

>55 years with weight loss and upper abdominal pain, dyspepsia or reflux

Question 8

What investigation in GORD?

Answer 8

Endoscopy to exclude malignancy and investigate complications: oesophagitis, Barrett’s oesopahgus, stricture.

24hour pH monitoring

Question 9

Management plan for GORD?

Answer 9

Conservative:
Avoid alcohol, coffee, fatty foods.
Weight loss
Smoking cessation
Have meals 3 hours before bed, raise head of bed

Medical:
PPI

Surgical:
Fundoplication - GO junction and hiatus are dissected and the fundus is wrapped around the GOJ recreasing the sphincter

Question 10

What are indications for surgery?

Answer 10

Failure to respond to medical therapy
Patient preference to avoid lifelong medication
Complications of GORD - pneumonia

Question 11

What are complications of GORD?

Answer 11

Aspiration pneumonia
Barrett's oesophagus
Oesophagitis
Oesophageal strictures
Oesophageal cancer