GORD

Question 1

Description: Describe what happens in GORD

Answer 1

Reflux of stomach acid (and bile) into the oesophagus. This acid is pathological

Question 2

Risk factors/Aetiologies: What are the risk factors and aetiologies of GORD?

Answer 2

Risk Factors:

• Pregnancy
• Obesity
• Drug that lower LOS pressure
• Smoking
• Alcohol
• Hypomobility

Aetiology
Abnormal anatomy = Hiatus hernia

Normal anatomy =

• Delayed gastric emptying
• Delayed oesophageal emptying
• Lower oesophageal sprinter hypotension
• Transient relaxation of the lower oesophageal sphincter

Question 3

Pathology: Describe the pathology of GORD (what happens when acid gets to oesophagus) (3)

Answer 3

Reflux of gastric acid to the oesophagus causes:

• THICKENING of squamous epithelium
• INFLAMMATION due to mucosa being exposed to acid-pepsin and bile (erosive oesophagitis)
• ULCERATION of the oesophagus in severe cases

Question 4

Symptoms: State the symptoms of GORD (6)

Answer 4

• Asymptomatic
• Sleep disturbance
• Heartburn - retrosternal chest pain
• Regurgitation
• Cough
• Water brash

Question 5

THE SIGNS WERE NOT IN THE LECTURE

Answer 5

THE SIGNS WERE NOT IN THE LECTURE

Question 6

Investigations: In GORD what investigations are needed:

(a) In the absence of ALARMS symptoms?
(b) In the presence of ALARMS symptoms?

Answer 6

(a) Absent - Diagnosis done on the basis of symptoms WITHOUT diagnostic testing

(b) Present:
- Endoscopy
- 24 hour oesophageal pH monitoring with/without manometry (helps diagnose when endoscopy is normal)

Question 7

Treatment: Describe the different treatment for GORD

(a) Lifestyle
(b) Pharmacological
(c) Surgery

Answer 7

(a) Weight loss, smoking cessation, alcohol reduction, eating small regular meals

(b) Drugs work by acid suppression:
- Alginates (Gaviscon) for symptom relief
- Proton pump inhibitors (Omeprazole) and hydrogen receptor blockers (Ranitidine) are both ANTACIDS that relieve symptoms by neutralising the acid

(c) Anti-reflux surgery (Fundoplication) - wrap fundus around lower oesophagus

Question 8

Complications: What are the complications of GORD:

Answer 8

• Carcinoma
• Oesophagitis
• Barrett’s oesophagus
• Ulceration
• Stricture formation (due to healing by fibrosis)

Question 9

Extra: What are the two types of hiatus hernia?

Answer 9

• Sliding

- Para-oesophageal

Question 10

Extra: What drugs/food lower oesophageal sphincter pressure and therefore result in increased reflux/heartburn?

Answer 10

• Nicotine
• Alcohol
• Dietary xanthines

Question 11

Extra: What is manometry?

Answer 11

Manometry will indicate how well the oesophagus can perform peristalsis.