GORD Flashcards
Definition
Clinical diagnosis: symptoms caused by reflux of gastric content into oesophagus and beyond (lung, oral cavity).
Complications of GORD (5)
Oesophagitis
Barrett’s oesophagus
Aspiration of reflux contents
Dental erosions
Laryngitis
Signs and symptoms of GORD
Common
- Heartburn
- Acid regurgitation
Less common
- Dysphagia
- Halitosis
- Enamel erosion
- Laryngitis
- Bloating
Risk factors for GORD (4)
Older age
Family Hx
Obesity
Hiatus hernia
Investigations for GORD
- 8 week trial on PPI
- If symptoms do not improve or if red flags, then further investigations.
Other investigations
- OGD= oesophagitis, Barrett’s, bolus.
- Manometry= achalasia, motor disorder
- Ambulatory pH monitoring= <4, 4% of the time.
- Barium swallow= if signs of dysphagia
Differentials for GORD
RULE OUT ACS
Stable agina
Achalasia
Oesophageal carcinoma
Peptic ulcer
Functional dyspepsia/ heartburn
Treatment for GORD
- PPI
- Omeprazole
- Esomeprazole
- Rabeprazole
- Lansoprazole - H2 antagonist adjunct?
- Rinitidine
- Cimetidine - Surgery if PPI tolerated, but not adherent
Barrett’s oesophagus
- Definition
Metaplastic change in the oesophagus due to prolonged exposure to acid
- Tissue change from stratified squamous epithelial to simple columnar epithelium.
Barrett’s oesophagus
- Treatment
PPI
Radiofrequency ablation
Surgery: fundoplication, oesophagectomy
Medication classes associated with dyspepsia (6)
- NSAIDs
- Bisphosphonates
- Steroids
- Nitrates
- Theophyllines
- Calcium antagonists
Barrett’s oesophagus risk factors
Male
Long-term GORD
Previous oesophagitis
Previous haitus hernia
Previous oesophageal strictures/ ulcers