GORD

Question 1

What causes GORD?

Answer 1

Reflux of the stomach acid into the lower oesophagus causing irritation

Question 2

What are some risk factors for GORD?

Answer 2

Hiatus hernia
Obesity
Weak oeopshgeal sphincter 
Esophageal dysmotility
Gastric acid hypersecretion
Pregnancy
Alcohol
Acidic foods 
H.Pylori infection

Question 3

What are the symptoms of GORD?

Answer 3

Retrosternal burning pain
Odynophagia- painful swallowing 
Chest pain
Dysphagia
Hoarse voice
Halitosis
Dental erosion

Question 4

What are some red flags for GI cancer?

Answer 4

Weight loss
IDA
Progressive obstruction
Anorexia
Upper GI bleeding

Question 5

What is the investigation for suspected upper GI malignancy?

Answer 5

OGD- Endoscopy

Question 6

What is the premalignant lesion that GORD leads to?

Answer 6

Barrett’s oesophagus

Manage the GORD
Regular OGD monitoring

Question 7

What is the most common complication of GORD?

Answer 7

Reflux oesophagitis- this can lead to inflammation of strictures forming which may cause dysphagia

Question 8

What change is seen in Barrett’s?

Answer 8

Normal squatified squamous epithelium changes to metaplastic columnar epithelium (as lines the stomach)

Question 9

How is Barrett’s confirmed?

Answer 9

BIopsy of the altered area- this change can develop into adenocarcinoma

Question 10

What cancer does Barrett’s increase the risk of developing?

Answer 10

Adenocarcinoma

Question 11

What test can be done to investigate lower esophageal sphincter function?

Answer 11

Esophageal manometry- this investigates for esophageal issues such achalasia and spasm. It records the pressures within the oesophagus.

Question 12

What is normal pressure in the esophageal sphincter?

Answer 12

Greater than 10 mmHg- if less than this it is reduced

Question 13

What is the conservative management for GORD?

Answer 13

Conservative- weight loss, eating less irritating food, less alcohol, less caffeine, elevate head of the bed to prevent nocturnal symptoms, don’t eat before bed, avoid triggering foods, smoking cessation

Question 14

What is the medical management for GORD?

Answer 14

Simple OTC antacids- e.g. Gaviscon

PPI- Lansoprazole, Omeprazole
H2 Antagonist- Ranitidine

Question 15

What might failure for medical management to control GORD indicate?

Answer 15

H.Pylori infection
Zollinger Ellison syndrome
Gastric cancer hyper secreting gastrin?

Question 16

What surgical option may be considered for GORD?

Answer 16

Laparoscopic fundoplication to restore LOS pressures

Question 17

What might be done to investigate GORD if endoscopy is normal?

Answer 17

pH monitoring could be carried out

Question 18

How can H.Pylori be tested for?

Answer 18

Carbon-13 breath test
Stool antigen

CLO Test- required biopsy obtained via biopsy. Test for presence of urease enzyme.

Question 19

Summarize the management options for GORD?

Answer 19

Conservative- weight loss, stop smoking, less alcohol, avoid trigger foods, sleep propped up to nocturnal symptoms

Medical- Omeprazole or Ranitidine

Surgery- Fundoplication

Question 20

What are some differentials for GORD?

Answer 20

Malignancy- red flags and dysphagia
Candida- immunosuppressed
Achalasia- difficulty swallowing
Pharyngeal pouch- bad breath
Zollinger Ellison Syndrome 
Cardiac disease for retrosternal pain 
Irritation from bisphosphonates