GORD

Question 1

What is the pathophysiology behind GORD?

Answer 1

reflux of acid from the stomach into the distal oesophagus causing mucosal irritation

Question 2

what are the risk factors for GORD?

Answer 2

decreased lower oesophageal tone e.g. due to hiatus hernia, smoking, alcohol
increased intra-abdominal pressure e.g. obesity, pregnancy, increased gastric volume

Question 3

what are some clinical features of GORD?

Answer 3

heartburn (related to meals, worse on lying down, relieved by antacids)
belching, 
odynophagia
nocturnal asthma
chronic cough
laryngitis, sinusitis

Question 4

what are some complications of GORD?

Answer 4

oesophagitis
ulceration
benign stricture
Barrett's oesophagus (metaplasia of squamous epithelium)
oesophageal adenocarcinoma

Question 5

What are some differentials for GORD?

Answer 5

oesophagitis, infection, IBD, burns, peptic ulcer disease, oesophageal cancer.

Question 6

When would you do an OGD in suspected GORD?

Answer 6

>55yrs
wt loss
symptoms for >4/52
dysphagia
persistent symptoms despite treatment

Question 7

what are some specific investigations you could do in suspected GORD?

Answer 7

OGD
barium swallow
24hr pH testing +/- manometry

Question 8

what are some conservative options in the management of GORD?

Answer 8

wt loss
stop smoking
reduce alcohol intake
small regular meals >3hrs before bed
raise the head of the bed
stop any offending drugs e.g. CCBs, nitrates, NSAIDs
avoid hot drinks and spicy food

Question 9

what are the medical options for GORD?

Answer 9

1. PPI lansoprazole 30mg OD for 1-2 months
2. no response double PPI dose
3. no response add H2 antagonist e.g 300mg ranitidine at night

antacids OTC can also be used such as gaviscon

Question 10

what surgical option if there for GORD?

Answer 10

Fundoplication- laparoscopic procedure where they mobilise the gastric fungus and wrap it round the lower oesophagus.
indications: severe symptoms, refractory to medical treatment, confirmed reflux on (monitor pH)