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Oesophagus > GORD > Flashcards

GORD Flashcards

1
Q

What is GORD

A

It’s a reflux disease whereby acid from the stomach leaks into the oesophagus causing irritation and retrosternal burning pain

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2
Q

What is the Epidemiology of GORD

A
  • Affects 25% of people in the western countries

- affects men more than women

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3
Q

What is the pathophysiology of GORD?

A

Normally the LOS controls the passage of contents into the stomach. There is episodic relaxation of the LOS however in GORD these periods of relaxation of the LOS are more frequent which allows the leakage of acid from the stomach into the oesophagus causing burning pain and mucosal damage

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4
Q

What are the anatomical features that normally prevent GORD

A
  • Right crus of diaphragm
  • acute angle of entry into the stomach
  • intra-abdominal pressure
  • LOS muscular element
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5
Q

What are the risk factors of developing GORD

A 
Age 
Male 
Alcohol 
Smoking 
Spicy food 
Obesity 
Caffeinated drinks
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6
Q

What are the clinical features of GORD

A
  • Chest pain ( retrosternally )
  • pain is worse after meals/lying down/straining/bending over
  • partially relieved by antacids
  • belching
  • chronic cough
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7
Q

What are the red flag symptoms of GI cancers

A 
Dysphagia 
Weight loss 
Early satiety 
Loss of appetite 
Malaise
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8
Q

What is the Los Angeles classification of reflux

A

Used to measure the severity of endoscopic findings of mucosal breaks caused by GORD

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9
Q

What are the differential diagnosis of GORD

A
  • Malignancy
  • Peptic ulceration
  • Oesophageal motility disorder
  • oesophagitis
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10
Q

How is the symptoms of GORD investigated.

A

It’s often a clinical diagnoses therefore a good history is needed and a trial with PPI to see if there is symptom resolution, if there is then you can be sure that it is GORD

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11
Q

What are the NICE guidelines for suspected upper GI malignancies needing urgent endoscopy

A
  • Patient above 55 years
  • unintentional weight loss
  • dysphagia
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12
Q

How would you investigate someone presenting with dysphagia who is above 55 years old

A

OGD is gold standard as Upper GI malignancy should be suspected unless proved otherwise.

OGD is mainly done to see the complications that GORD can lead to such as oesophageal carcinoma, Barrett oesophagus, strictures, oesophagitis

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13
Q

47 year old woman presents with Retrosternal pain and a chronic cough which is not relieved by antacids/PPIs
How should you investigate her

A
  • OGD to look for complications
  • 24 hours pH monitoring is the gold standard however
  • the above should be combined with oesophageal manometry
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14
Q

Explain what happens in pH monitoring studies

A

pH studies assess the amount of time the acid is in the oesophagus and the correlation of acid leak into the oesophagus with the experience of patient symptoms.
The above produces a score called the DeMeester score

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15
Q

What is the conservative management for GORD

A

Avoid triggers eg - caffeine, alcohol, spicy foods
Lose weight
Smoking cessation

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16
Q

What is the medical management for GORD

A
  • PPI ( should be done in addition to the lifestyle changes)

- PPIs will be lifelong unless surgery is carried out

17
Q

What are the 3 indications for surgery for GORD

A
  1. Failure to respond to other management strategies conservative and medical
  2. Patient doesn’t want to take life long medications
  3. Patients with complications of GORD eg - Barrett’s, oesophagitis, resp complications like pneumonia/bronchiectasis due to aspiration
18
Q

What is the surgical intervention that is offered to patients with GORD

A
  • Nissen fundoplication - 360 posterior wrap using the fundus of the stomach to reinforce the GOJ
19
Q

What are the main side effects of fundoplicaiton

A
  • dysphagia
  • bloating
  • inability to vomit

These side effects settle after approximately 6 weeks post surgery

20
Q

What are some new surgical treatments out for treating GORD

A

Stretta®: uses radio-frequency energy delivered endoscopically to cause thickening of the lower oesophageal sphincter

Linx®: a string of magnetic beads is inserted around the lower oesophageal sphincter laparoscopically which tightens the LOS

21
Q

What are the main complications of GORD

A 
Aspiration Pneumonia 
Barrett’s oesophagus
Oesophagitis 
Oesophageal strictures 
Oesophageal cancers
22
Q

Many patients have advanced disease at time of diagnosis therefore need palliative care. What options are available to those patients

A
  1. Oesophageal stents to help dysphagia
  2. Radiotherapy/chemotherapy
  3. Photodynamic therapy
  4. Nutritional support
  5. Gastrostomy
23
Q

What is the prognosis of oesophageal cancer

A

5-10% survive 5 years

Oesophagus (5 decks)

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