GORD Flashcards
What is it?
- Incompetent lower oesophageal sphincter- there are more transient LOS relaxations than normal allowing gastric acid to flow back into the oesophagus
- Poor oesophageal clearance
- Barrier function/visceral sensitivity
Who gets GORD?
Very common within population
Made more likely by LO pressure & high abdominal pressure (pregnancy)
How does GORD present?
-Heartburn
-Acid Reflux
-Waterbrash (sudden flow of saliva associated with indigestion)
Dysphagia
Odynophagia
Wt loss
Chest pain
Hoarseness
Coughing
What is heartburn?
Burning which is worse bending, stooping or lying down
How is GORD diagnosed?
Clinical diagnosis if no alarm symptoms
-if alarm: Endoscopy Ba swallow Oesophageal manometry & pH studies Nuclear studies If no response to PPIs then intraluminal monitoring (calculated by DeMeester score)
Aims of treating GORD?
Aims:
symptom relief
Healing oesophagitis
Prevent complications
Treating GORD?
PPIs (omeprazole 30mg) Lifestyle modifications (smoking/alcohol/wt loss) Antacids (alginate containing) H2 antagonists Surgery
What are antacids good for?
Healing and complication prevention
What are H2 antagonists for?
Cimetidine: good symptom relief, ineffective for healing
Ranitidine: Tolerance after 4 weeks of therapy, poor in preventing relapse and complications
What type of surgery occurs?
Nissen fundoplication
What does the surgery do?
Controls symptoms
Heals oesophagitis
Offered to young patients with severe/unresponsive disease
Prognosis of GORD?
10% of patients: barrett’s oesophagus, this is irreversible and increases risk of adenocarcinoma
Complications of GORD?
Regurgitation: can lead to aspiration pneumonia if there is an accompanying obstruction and can cause a cough
When to refer for endoscopy?
Patients with evidence of a GI bleed (melaena/coffee ground vomiting)
What type of bacteria is H.Pylori?
Gram negative aerobic bacteria
What does H. Pylori produce?
Ammonia to neutralize stomach acid, directly damaging the epithelial cells
How long must you not take a PPI before testing for H. Pylori?
2 weeks
Tests for H.Pylori?
Urea breath test: using radiolabelled carbon
Stool antigen test
Rapid urease test: performed during endoscopy
What is a rapid urease test?
Also known as CLO test
performed during endoscopy and involves taking small biopsy of stomach mucosa. Urea is added to this sample if HP is present they produce urease enzymes that convert urea to ammonia
Eradication of H. Pylori?
Triple therapy
- PPI
- 2 types of ABs (amoxicillin/clarithromycin 7 days)
