GORD

Question 1

What is it?

Answer 1

• 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

Question 2

Who gets GORD?

Answer 2

Very common within population

Made more likely by LO pressure & high abdominal pressure (pregnancy)

Question 3

How does GORD present?

Answer 3

-Heartburn
-Acid Reflux
-Waterbrash (sudden flow of saliva associated with indigestion)
Dysphagia
Odynophagia
Wt loss
Chest pain
Hoarseness
Coughing

Question 4

What is heartburn?

Answer 4

Burning which is worse bending, stooping or lying down

Question 5

How is GORD diagnosed?

Answer 5

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)

Question 6

Aims of treating GORD?

Answer 6

Aims:
symptom relief
Healing oesophagitis
Prevent complications

Question 7

Treating GORD?

Answer 7

PPIs (omeprazole 30mg)
Lifestyle modifications (smoking/alcohol/wt loss)
Antacids (alginate containing)
H2 antagonists 
Surgery

Question 8

What are antacids good for?

Answer 8

Healing and complication prevention

Question 9

What are H2 antagonists for?

Answer 9

Cimetidine: good symptom relief, ineffective for healing
Ranitidine: Tolerance after 4 weeks of therapy, poor in preventing relapse and complications

Question 10

What type of surgery occurs?

Answer 10

Nissen fundoplication

Question 11

What does the surgery do?

Answer 11

Controls symptoms
Heals oesophagitis
Offered to young patients with severe/unresponsive disease

Question 12

Prognosis of GORD?

Answer 12

10% of patients: barrett’s oesophagus, this is irreversible and increases risk of adenocarcinoma

Question 13

Complications of GORD?

Answer 13

Regurgitation: can lead to aspiration pneumonia if there is an accompanying obstruction and can cause a cough

Question 14

When to refer for endoscopy?

Answer 14

Patients with evidence of a GI bleed (melaena/coffee ground vomiting)

Question 15

What type of bacteria is H.Pylori?

Answer 15

Gram negative aerobic bacteria

Question 16

What does H. Pylori produce?

Answer 16

Ammonia to neutralize stomach acid, directly damaging the epithelial cells

Question 17

How long must you not take a PPI before testing for H. Pylori?

Answer 17

2 weeks

Question 18

Tests for H.Pylori?

Answer 18

Urea breath test: using radiolabelled carbon
Stool antigen test
Rapid urease test: performed during endoscopy

Question 19

What is a rapid urease test?

Answer 19

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

Question 20

Eradication of H. Pylori?

Answer 20

Triple therapy

• PPI
• 2 types of ABs (amoxicillin/clarithromycin 7 days)