GORD Flashcards
What is GORD?
Reflux of stomach acid back through the LOS, iritating the oesophageal lining.
Why is the oesophagus affected by the acid and not the stomach?
Oesophagus has a squamous epithelial lining.
Stomach has columnar epithelial lining and bicarbonate-rich mucus.
What causes the reflux to occur?
Transient relaxation of the LOS
How does GORD present?
Burning retrosternal chest pain:
- Worse when flat
- Worse with certain foods
- Hoarse voice
- Acid brash (acid in throat, salivate more- water brash)
- Cough
When should you do an OGD in GORD?
Concerning Features/Red Flags
- Dysphagia
- Age 55+
- Weight Loss
- Bleeds
When should you admit urgently?
Bleeds:
- Melaena
- Coffee ground
- Low Hb
How is GORD conservatively managed?
- Reduce caffeine and citrus
- Smaller, lighter meals
- Don’t eat before bed
- Weight loss
What OTC medication should be tried first?
- Gaviscon
- Rennie
How do Gaviscon and Rennie work?
Antacids
What drug should be prescribed first hand?
PPIs
What else may be prescribed for GORD?
Ranitidine
How does Ranitidine work?
H2 antagonist
- Blocks parietal cell stimulation
What surgery is used for GORD?
Fundoplication
How does fundoplication work?
Narrows the LOS
What can predispose to GORD and gastritis?
H.pylori
What is H.pylori
Gram negative helical bacteria
Is H.pylori aerobic or anaerobic?
Aerobic
How does H.pylori avoid the gastric acid?
Sits in the gastric mucosa
How does H.pylori cause epithelial damage?
Breaks the gastric mucosa, exposing the epithelial lining underneath to the acid
What does H.pylori produce?
Ammonia (neutralises HCl)
Who gets a H.pylori test?
Anyone with dyspepsia
What are the H.pylori tests?
- Urea breath test using radiolabelled C-13
- Stool antigen test
- Rapid urease test (on endoscopy)
What is the rapid urease test?
CLO Test
- Biopsy on endoscopy
- Add urea to the sample
- H.pylori will use urease to turn the urea to ammonia
- Sample turns alkaline
How is H.pylori treated?
Triple eradication
What is triple eradication?
- Lansoprazole
- Clarithromycin
- Amoxicillin
How does lansoprazole work?
PPI
How does clarithromycin work?
Protein synthesis inhibition
Think Clarithromyprotein
How does amoxicillin work?
Beta-lactam- inhibits peptidoglycan cell wall
What is Barrett’s Oesophagus?
Metaplasia
- Squamous to columnar epithelium
What happens to the symptoms with Barrett’s?
Symptoms tend to improve
What is the lifetime risk of malignancy with Barrett’s?
5%
What cancer can Barrett’s cause?
Adenocarcinoma
How is Barrett’s treated?
PPI
What else is useful to prevent adenocarcinoma in Barrett’s?
Regular aspirin
How might Barrett’s be resolved?
Destruction of the epithelium so it can regenerate:
- Cryotherapy
- Radiotherapy
