GORD

Question 1

What is GORD?

Answer 1

When reflux of stomach contents causes troublesome symptoms and/or complications

Question 2

What is the effect on the lower oesophageal sphincter normally?

Answer 2

It remains closed and then relaxes when swallowing to allow food to enter the stomach

Question 3

What happens to the lower oesophageal sphincter in GORD?

Answer 3

It has lower reduced tone and there are more transient LOS relaxations so gastric acid is able to flow back into the oesophagus

Question 4

What are the contributing factors to GORD?

Answer 4

1. LOS relaxes transiently, independently of a swallow, after meals
2. Increased mucosal sensitivity to gastric acid
3. Reduced esophageal clearance of acid contribute
4. Delayed gastric emptying and prolonged post-prandial (after eating) and nocturnal reflex also contribute
5. A hiatus hernia can impair anti-reflux mechanisms and thus contribute

Question 5

What are the risk factors of GORD?

Answer 5

• Lower oesophageal sphincter hypotension
• Hiatus hernia
• Loss of oesophageal peristaltic function
• Gastric acid hyper secretion
• Slow gastric emptying
• Scleroderma
• Factors that weaken the lower oesophageal sphincter such as abdominal obesity, fat-risk diet and smoking

Question 6

What are the symptoms of GORD?

Answer 6

• New onset heartburn
• Belching
• Food/acid brash
• Water breaks (increased salivation)
• Odynophagia (painful swallowing)

Question 7

What are 3 signs that would make you suspect GORD?

Answer 7

• Laryngitis
• Sinusitis
• Chronic cough and nocturnal asthma

Question 8

What investigations would usually be performed if GORD was expected?

Answer 8

None - diagnosis can usually be made without investigation

Question 9

When would you do an endoscopy in suspected GORD?

Answer 9

• If symptoms persists for more than 4 weeks
• If there is persistent vomiting
• GI bleeding
• Palpable mass
• Over 55
• Symptoms despite being treated

Question 10

What test can you use to diagnose a hiatus hernia?

Answer 10

A barium swallow

Question 11

What is the main complication of GORD?

Answer 11

Barretts oesophagus

Question 12

What is Barretts Oesophagus?

Answer 12

When the distal oesophageal epithelium undergoes metaplasia from stratified squamous to columnar

Question 13

What is the non-pharmacological treatment for GORD?

Answer 13

• Encourage weight loss
• Smoking cessation
• Small regular meals
• Avoid hot drinks, alcohol, citrus fruits, spicy food and eating less than 3 hours before bed

Question 14

Give an example of an antacid?

Answer 14

Alginate containing antacids e.g gaviscon

Question 15

Give an example of a proton pump inhibitor?

Answer 15

Lansoprazole, Omeprazole

Question 16

Give an example of a H2 antagonist?

Answer 16

Ranitidine

Question 17

What is the surgical option for GORD?

Answer 17

• Nissen fundoplication where the gastric fungus is wrapped around the lower oesophageal sphincter to make it tighter.

Question 18

What is hilocobacter pylori?

Answer 18

Gram negative aerobic bacteria that lives in the stomach and it causes damage to the epithelia lining leading to gastritis, ulcers and an increased risk of stomach cancer.

Question 19

How does H pylori avoid being destroyed by the stomach acid.

Answer 19

It goes into the gastric mucosa making holes in it which exposes the epithelial cells underneath to be exposed to the acid.

Question 20

What does H pylori produce and what effect does this have on the body?

Answer 20

Ammonia - lowers to stomach acid and directly damages the epithelial cells.

Question 21

What is dyspepsia?

Answer 21

Broad term for indigestion

Question 22

How do we test for H pylori?

Answer 22

• Urea breath test using radiolabelled carbon 13
• Stool antigen test
• Rapid urease test can be performed during endoscopy.

Question 23

How is H pylori treated?

Answer 23

Triple therapy involving triple therapy with a proton pump inhibitor (e.g. omeprazole) plus 2 antibiotics (e.g. amoxicillin and clarithromycin) for 7 days.