GORD

Question 1

Define GORD

Answer 1

Pathologically excessive entry of gastric contents into oesophagus

Question 2

How frequent is reflux in normals?

Answer 2

Up to 5% of the time

Question 3

Most affected age group

Answer 3

Middle-aged adults

Question 4

Causative refluxed agents (2)

Answer 4

1 gastric acid 2 bile

Question 5

What factors contribute to GORD

Answer 5

1 reduced LOS tone 2 increased intragastric pressure

Question 6

What causes reduced LOS tone? (5)

Answer 6

1 previous surgery 2 alcohol 3 drugs 4 existing peptic stricture 5 idiopathic

Question 7

Increased intragatric pressure is caused by? (3)

Answer 7

1 coughing 2 delayed gastric emptying 3 large meals

Question 8

What are the pathological features of GORD (3)

Answer 8

1 oesophagitis 2 stricture formation 3 Barrett’s oesophageal metaplasia

Question 9

How many grades of oesophagitis exist?

Answer 9

Grades I to IV

Question 10

Describe grade I oesophagitis (2)

Answer 10

1 minor mucosal erythema 2 with erosions

Question 11

Describe grade IV oesophagitis (3)

Answer 11

1 extensive circumferential 2 ulceration 3 with strictures

Question 12

What leads to stricture formation in GORD (2)

Answer 12

1 epithelial destruction 2 and fibrosis

Question 13

What does stricture formation in GORD lead to? (2)

Answer 13

1 narrowing and 2 shortening of lower oesophagus

Question 14

Danger of fixation caused by oesophageal stricture

Answer 14

Further reflux

Question 15

Changes in Barrett’s metaplasia (2)

Answer 15

1 stratified squamous epithelium 2 to columnar epithelium

Question 16

Possible dangerous changes in columnar epithelium

Answer 16

1 dysplasia 2 premalignant changes

Question 17

Symptoms of GORD (3)

Answer 17

1 dyspepsia which 2 (may) radiate to back and left neck 3 true reflux (acid in pharynx)

Question 18

When are the symptoms of GORD worst

Answer 18

1 night 2 after large meal 3 when recumbent

Question 19

What causes dysphagia in GORD?

Answer 19

Associated ulceration or stricture

Question 20

Are symptoms of GORD common in under 45’s?

Answer 20

Yes

Question 21

Management of GORD in under 45’s (2)

Answer 21

1 empirical treatment 2 investigation when symptoms persist

Question 22

Investigation of GORD in over 45’s? (2)

Answer 22

1 24h continuous pH monitoring 2 OGD

Question 23

Diagnostic criterion in 24h pH for GORD

Answer 23

Peaks in pH correspond with symptoms

Question 24

Role of OGD in GORD

Answer 24

Exclude oesophageal cancer

Question 25

Considerations for medical treatment of GORD (3)

Answer 25

1 reduce acid reflux 2 oppose acid secretion 3 promote gastric and oesophageal emptying

Question 26

How is acid reflux reduced (3)

Answer 26

1 Reduce smoking 2 lose weight 3 reduce alcohol consumption

Question 27

How is gastric acid secretion counteracted? (2)

Answer 27

1 PPI (omeprazole 20 mg od P.O.) 2 antacid (gaviscon 10mL od po)

Question 28

How is oesophageal/gastric emptying promoted?

Answer 28

Promotilants (metoclopramide 10mg TDS P.O.)

Question 29

How is GORD treated surgically (2)

Answer 29

1 laprascopic 2 nissen’s fundoplication

Question 30

Indications for surgical treatment of GORD

Answer 30

1 failure of maximal medical treatment 2 large volume reflux with risk of aspiration 3 complications of reflux

Question 31

Complications of GORD

Answer 31

1 stricture 2 severe ulceration 3 Barrett’s oesophageal metaplasia