GORD

Question 1

What is GORD?

Answer 1

Gastro oesophageal reflux disease. It is a prolonged or recurrent reflux of the gastric contents into the oesophagus

Question 2

What is the clinical presentation of GORD?

Answer 2

Heart burn - related to lying down or meals
Odynphagia - painful swallowing
Regurgitation

Question 3

What is the pathophysiology of GORD?

Answer 3

Tone of LOS is reduced as well as frequent transient relaxations of the LOS
Increased mucosal sensitivity to acids
Hiatus hernia can cause increased reflux
Reflux can occur without one

Question 4

What is a hiatus hernia?

Answer 4

A condition where part of the stomach pushes up into the lower chest through a weakness in the diaphragm

Question 5

What is the aetiology of GORD?

Answer 5

Smoking, alcohol, pregnancy, obesity, hiatus hernia anything related to loss of LOS function

Question 6

What is the epidemiology of GORD?

Answer 6

2/3 times more common in men

20% of adults experience heartburn

Question 7

What diagnostic tests are done for GORD?

Answer 7

Endoscopy
Barium swallowing - to show hiatus hernia
Oesophagus pH monitoring

Question 8

What is the treatment of GORD?

Answer 8

Lifestyle changes - avoid alcohol, stop smoking and weight loss. PPI (proton pump inhibitors). H2 receptor antagonist

Question 9

What PPI would you use?

Answer 9

Omeprazole,

Question 10

What is the mechanism of action of omeprazole?

Answer 10

Proton pump inhibitors act by irreversibly blocking the hydrogen/potassium adenosine triphosphatase enzyme system (the H+/K+ ATPase, or, more commonly, the gastric proton pump) of the gastric parietal cells.

Question 11

What H2 receptor antagonist would you use?

Answer 11

Cimetidine

Question 12

What is the mechanism of action of H2 receptor antagonists?

Answer 12

Histamine H2 receptor antagonists act competitively with histamine at receptors on gastric parietal cells. They reduce basal acid secretion and pepsin production and prevent the increase in secretion that occurs in response to several secretory stimuli

Question 13

What are the complications of GORD?

Answer 13

Oesophageal stricture formation - worsening dysphagia

Barrett’s oesophagus

Question 14

What is Barrett’s Oesophagus

Answer 14

Abnormal columnar epithelium replaces the squamous epithelium of the distal oesophagus
Irreversible
Can develop into oesophageal cancer