GORD Flashcards
describe the treatment of GORD without endoscopy.
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)
describe the management of GORD.
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
what are complications of GORD?
oesophagitis barrett's oesophagus oesophageal cancer anaemia ulcers benign strictures
what is barrels oesophagus managed?
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
what is the standard approach for an oesophagectomy?
ivor lewis
others;
- left thorax-abdominal
- transhiatal
- total oesophagectomy with cervical oesophagatsric anastomoses
what is the main surgical complication from an oesophagectomy?
anastomotic leakage
if there is an intrathoracic anastomotic leakage, this can cause mediastinitis which has a high mortality
what are indications for an upper GI endoscopy in a patient who presented with dyspeptic / reflux symptoms?
> 55yrs symptoms > 4 week or persistent despite treatment relapsing symptoms weight loss dysphagia
in the investigation of dyspepsia/reflux symptoms, if upper GI endoscopy was negative what would be the next step?
24 hour oesophageal PH monitoring