GORD

Question 1

what is it?

Answer 1

LOS dysfunction–> reflux of gastric contents into oesophagus –> oesophagitis

*opposite of achalasia*

Question 2

aetiology?

Answer 2

• idiopathic
• secondary to
  
  • smoking
  • alcohol
  • obesity
  • pregnancy

Question 3

symptoms?

Answer 3

• dyspepsia
  
  • heartburn
  • regurgitation
  • retrosternal/ epigastric pain
  • bloating
  • nocturnal cough
  • hoarse voice

Question 4

ALARM Symptoms to warrant endoscopy?

Answer 4

Anorexia

Loss of weight (unintentional)

Anaemia

Recent onset >55years

Mass / melaena (GI bleed)

Swallowing problems (dysphagia)

Question 5

Ix?

Answer 5

1. PPI trial

if no improvement

2. endoscopy

others to consider:

• ambulatory 24h pH monitoring
• oesophageal manometry
• barium swallow

Question 6

what would be seen on 24h pH monitoring & manometry that would be indicative of GORD?

Answer 6

• 24h pH monitoring
  
  • pH <4 more than 4% of the time- abnormal
• manometry
  
  • low pressure at GOJ

Question 7

Mx?

Answer 7

• conservative - wt loss, avoidance of smoking and alcohol
• medical
  
  • simple antacids
  • H2 blockers
  • PPI
• surgery: laparoscopic fundoplication

Question 8

complications?

Answer 8

• reflux oesophagitis
• benign strictures (healing by fibrosis)- aka Schatzki ring
• barrett’s oesophagus