GORD

Question 1

Define GORD

Answer 1

Reflux of stomach contents leading to troublesome Sx

Question 2

Prolonged GORD can lead to (3)

Answer 2

Oesophagitis
Benign oesophagus
Barretts oesophagus

Question 3

What is GORD a risk factor for?

Answer 3

Cancer

Question 4

Causes of GORD (13)

Answer 4

Abdominal obesity 
Overreating 
Smoking 
Alcohol/caffeine 
Hiatus hernia 
Pregnancy 
Loss oesophageal peristaltic fct
Abnormal LOS 
Delayed gastric emptying 
Shortening oesophagus - b/c chronic oesphagitis 
Incr IAP 
Bile in stomach 
FHx GORD

Question 5

Sx GORD (7)

Answer 5

Heartburn 
Belching 
Acid brash 
Water brash 
Odynophagia 
Dysphagia 
Recent Hx W gain

Question 6

Why can GORD mimic angina?

Answer 6

B/c reflux induced eosphageal spasm

Question 7

Use of barium swallow in GORD

Answer 7

Diagnose anatomical problems

Question 8

What blood test should be done in GORD and why?

Answer 8

FBC

Exclude anaemia

Question 9

Use of endoscopy in GORD

Answer 9

ID upper GI/identify complications

Question 10

Grade 1 Oesophagitis

Answer 10

Single or multiple erosions on a single fold

Erosions may be exudative or erythematous

Question 11

Grade 2 Oesophagitis

Answer 11

Multiple erosions affecting multiple folds

Erosions may be confluent

Question 12

Grade 3 Oesophagitis

Answer 12

Multiple circumferential erosions

Question 13

Grade 4 Oesophagitis

Answer 13

Ulcer, stenosis or oesophageal shortening

Question 14

Grade 5 Oesophagitis

Answer 14

Barrett’s epithelium.

Columnar metaplasia in the form of circular or non circulr (islands/tongue) extensions

Question 15

Define Barrett’s oesophagus

Answer 15

Part of normal distal squamous epithelium has been replaced by metastatic columnar epithelium above GOJ

Question 16

What % pt with GORD have Barretts

Answer 16

5%

Question 17

2 factors which are protective against developing oesophageal carcinoma

Answer 17

NSAIDs

H.pylori

Question 18

How often should a patient with Barrett’s oesophagus have endoscopy + biopsy?

Answer 18

yearly

Question 19

If a patient w/ Barrett’s oesophagus has low dysplasia, what should be done next?

Answer 19

> surveillance every 6 months

Question 20

Is GORD common in children?

Answer 20

Yes, very

Question 21

What causes GORD in children

Answer 21

Inappropriate relaxation of LOS due to functional immaturity
Fl diet
Mainly horizontal position
Short intraabdominal length

Question 22

@ what age do most reflux Sx resolve spontaneously in children?

Answer 22

12 months age

Question 23

> severe reflux is more commmon in children w/:

Answer 23

Neurodevelopmental disorders
Preterm infants
FOllowing surgery; oesophageal atresia, diaphragmatic hernia

Question 24

PS GORD paeds (6)

Answer 24

Recurrent regurg/vomiting 
Witnessed choking 
Respiratory problems 
Feedings/behaviour problems 
Failure to thrive 
Heartburn

Question 25

Ix paeds GORD

Answer 25

Clinical diagnosis usually

Question 26

When should you do further investigations in paeds GORD? (3)

Answer 26

If Hx atypical Complications present Failure to respond to Tx

Question 27

Further Ix paeds GORD (4)

Answer 27

24hr oesoph pH monitoring 24hr impedance screening Endoscopy + biopsies Contrast studies

Question 28

What conditions do you need to rule out with paeds GORD (6)

Answer 28

``` Congenital hiatus hernia Gastroenteritis Pyloric stenosis UTI Intestinal obstruction Cows milk protein allergy ```

Question 29

Mx paeds GORD

Answer 29

Reassure parents Add thickening agents to feed Put baby @ 30' after feeding If > severe - Ranitidine/omeprazole

Question 30

Complications paeds GORD (7)

Answer 30

``` FTT Oesophagitis Recurrent pulmonary aspiration Dystonic neck posturing Apparent life threatening events Barrett's Sudden infant death syndrome ```