GORD Flashcards

1
Q

describe the treatment of GORD without endoscopy.

A

review medications for possible cause of dyspepsia

lifestyle advice

high dose PPI for 1 month or ‘test and treat’ for H.pylori
(if no response to one then try the other)

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2
Q

describe the management of GORD.

A

GORD diagnosed without endoscopy should be treated as per dyspepsia guidelines

  • high dose PPI for one month or ‘test and treat’ for H.pylori
  • review meds and lifestyle advice

endoscopy proven oesophagitis;

  • full dose PPI for 1-2 months
  • if responds then low dose as required
  • if no response then double dose PPI for 1 month

endoscopy negative oesophagi’s

  • full dose PPI for 1 month
  • if response then offer low dose as required
  • if no response then H2 receptor antagonist or prokinetic for 1 month
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3
Q

what are complications of GORD?

A
oesophagitis 
barrett's oesophagus 
oesophageal cancer 
anaemia
ulcers
benign strictures
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4
Q

what is barrels oesophagus managed?

A

endoscopic surveillance with biopsies every 3-5 yrs

high dose PPI

if dysplasia is identified then offer endoscopic intervention

  • radio frequency ablation
  • endoscopic mucosal resection
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5
Q

what is the standard approach for an oesophagectomy?

A

ivor lewis

others;

  • left thorax-abdominal
  • transhiatal
  • total oesophagectomy with cervical oesophagatsric anastomoses
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6
Q

what is the main surgical complication from an oesophagectomy?

A

anastomotic leakage

if there is an intrathoracic anastomotic leakage, this can cause mediastinitis which has a high mortality

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7
Q

what are indications for an upper GI endoscopy in a patient who presented with dyspeptic / reflux symptoms?

A
> 55yrs 
symptoms > 4 week or persistent despite treatment 
relapsing symptoms 
weight loss 
dysphagia
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8
Q

in the investigation of dyspepsia/reflux symptoms, if upper GI endoscopy was negative what would be the next step?

A

24 hour oesophageal PH monitoring

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