GORD Flashcards
What is GORD caused by
Cause by reflux of stomach contents acid +- bile causing symptoms /complications LOS hypotension Hiatus hernia Oesophageal dysmotility Obesity Gastric hypersecretion Delayed gastric emptying smoking Alcohol Pregnancy Drugs H pylori
There are two symptoms types what are they
Oesophageal
Extra oesophageal/atypical
Symptoms of GORD
Oesophageal: Heart burn retrosternal discomfit after meals, lying, stooping, straining and is relived by antacids Belching Acid brash Water brash inc salivation Odynophagia Extra oesophageal Coppery cough Hoarse voice - laryngitis Nocturnal asthma Sinusitis
Complications of GORD
Oesophagitis Ulcers Benign stricture Iron deficiency Metaplasia -> dysplasia -> neoplasia GORD may lead to Barrett’s oesophagus a premalignant change in the cells on the lower oesophagus where they change from squamous to columnar can progress to oesophageal cancer
Differential diagnoses
Oesophagitis from corrosive, NSAIDS, herpes. Candida Duodenal /gastric ulcers or cancers Non ulcer dyspepsia Oesophageal spasm Cardiac disease
Tests in GORD
Endoscopy if dysphagia, over 55 or ALARMS symptoms or treatment refractory dyspepsia.
24h oesophageal pH monitoring +- manometry to help diagnose GORD when endoscopy is normal
GORD treatment
Treatment
Conservative - weight loss, smoking cessation, small regular meals, reduce hot drinks, alcoholic, citrus fruit, spice, fizzy, caffeine, avoid eating less than 3 hours before sleep and raise the bed head.
Medical
Antacids- magnesium triscilate or alginates gavsicon
Add PPI for refractory symptoms
H2 blocker
Avoid drugs affecting oesophageal motility, nitrates, cholinergics, CCB, as they relax the LOS , or NSAIDS, K+ SALTS bisphosphinates as they can damage the mucosa
Surgical
Aim to increase the resting LOS pressure
Nissen fundoplication
Laparoscopic insertion of a magnetic bead band or radio frequency induced hypertrophy
Only in severe GORD
Types of hiatus hernia
Sliding -80%
Parsoesohageal - rolling -20%
