GORD

Question 1

Causes

Answer 1

Anatomical disruption of gastro-oesophageal junction e.g. hiatus hernia

Calcium channel blocker e.g. amlodipine relaxes lower oesophageal sphincter and so increases risk of reflux

Hypotensive lower oesophageal sphincter

delayed acid clearance

causes of these:

hiatus hernia

ciagrette smoking (2 and 3)

Question 2

Clinical feature

Answer 2

Retrosterna, burning

regurgitation

atypical symptoms: dysphagia / odynophagia / water (saliva) brash / globes / asthma / cough

Worse at night and lying down

Question 3

Complications

Answer 3

Oesophagitis

Barrett’s oesophagus - metaplasia of the stratified squamous cells of oesophagus to columnar cells due to acid exposure.

strictures

Question 4

Investigations

Answer 4

Imaging: OGD with or without biopsy

special investigations: 24 hour pH test, oesophageal manometry

Question 5

Management

Answer 5

Conservative:

diet

weight loss

Medical: simple antacids, proton pump inhibitors

surgical: Nissans fundoplication