GORD Flashcards
What is it?
What is the most common cause?
Reflux of stomach contents into the oesophagus
LOS dysfunction
Causes - Medical:
Hiatus hernia - which one is more common? - Pics
Another big cause linked to ulcers?
Only in women?
What will cause oesophageal dysmotility?
Happens in diabetes?
Sliding - 80%
Rolling - 20%
Gastric acid hypersecretion
Pregnancy
Systemic sclerosis
Delayed gastric emptying
Causes - Lifestyle - 4
Obesity
Overeating
Alcohol
Smoking
Causes - Medications
Cardiac med - 2
Incontinence - 1
Used to stop pregnancy - 1
Pain med - 1
Beta-blockers and calcium channel blockers
Anticholinergics
Oral contraceptives
NSAIDs
Heartburn pain:
S - where is it? O C - how does the pain feel? R A T - when is it worse? E - what makes it worse and what meds make it better? S
Epigastric
Burning pain
Worse after eating
Bending over or lying down
Relieved by antacids
Heartburn is the obvious symptom
What are some other typical sign? -think Jenny at the care home
Stomach acid coming up into the esophagus and irritating the larynx. What 2 symptoms does this cause?
What resp disease could it cause in the night? -Nocturnal ______
What does the acid regurgitation lead to? -also known as acid brash
Belching
- Cough
- Hoarseness
Reflux laryngitis is caused by stomach acid coming up into the esophagus and irritating the larynx. This can cause chronic swelling of the vocal folds and hoarseness.
Nocturnal asthma
If you are often bothered with heartburn, it could be that the stomach acid coming back up the esophagus to the larynx triggers a bronchial spasm. That can make you wheeze and make it harder to catch a breath.
Acid brash (acid regurgitation) - hyper salivating
How is it usually diagnosed and after what?
Clinically
Usually after a trial of PPI’s
Investigation:
Endoscopy is needed if there are ALARM Signs of malignancy. What are the ALARM Signs?
What other features do you find for malignancy? - 2
Anaemia - Upper GI bleeding (or iron deficiency anaemia)
Loss of weight
Anorexia
Recent onset/progressive symptoms - vomiting, dyspepsia
Melaena/haematemesis
Swallowing difficulty - Dysphagia
Age > 55 years
Epigastric mass
Investigations:
What may endoscopy show in the oesophagus? - 3
How long before endoscopy does a PPI need to be stopped?
Oesophagitis
Barrets Oesophagus - precancerous
Oesophageal cancer
2 wks
Investigations:
A naso-oesophageal catheter or wireless radiotelemetry can be done if the clinical picture and endoscopy aren’t diagnostic.
What do they do?
24 hour pH monitoring
If < 4 for >4% of 24 hour period is diagnostic
Management of dyspepsia:
What should be done in the first month?
What should be done if GORD suspected rather than an ulcer? (HEARTBURN PREDOMINATES)
What should be done if still symptomatic?
Review medications and try lifestyle changes
PPI therapy for 1-2 months
H.pylori testing - PPI stopped 2 wks before
Management:
Lifestyle changes - 2
How to change eating habits?
Long term management
Reduce alc and smoking
Lose weight and exercise
Reduce spicy and fatty foods
Have small regular meals
Avoid eating < 3 hrs before bed
Raise the bed head
Low dose PPI if symptoms recur but ideally aim to use antacids
Management:
What drugs can affect motility? - 2
What drugs can damage the mucosa? - 2
What other drugs are available other than PPI’s? -2
Anticholinergics
Calcium channel blockers
NSAIDs
Potassium salts
Antacids
H2 blockers
Complications - 4
Oesophagatiis
Oesophageal ulcers
Benign oesophageal strictures (peptic stricture)
Barrett’s oesophagus
PPI - 4 examples
MOA
Omeprazole
Esomeprazole
Lansoprazole
Pantoprazole
Inhibits the proton pump of gastric parietal cells
