GORD

Question 1

Presentation

Answer 1

Dyspepsia
Heartburn
Acid regurg
Retrosternal or epigastric pain
Bloating 
Nocturnal Cough 
Hoarse Voice

Question 2

Red flag features for referral

Answer 2

• Dysphagia(difficulty swallowing) at any age gets a two week wait referral
  
  • Aged over 55 (this is generally the cut off for urgent versus routine referrals)
  • Weight loss
  • Upper abdominal pain / reflux
  • Treatment resistant dyspepsia
  • Nausea and vomiting
  • Low haemoglobin
  • Raised platelet count

Question 3

Management of GORD

Answer 3

• Reduce caffeine and alcohol
  
  • Weight loss
  • Avoid smoking
  • Smaller, lighter meals
  • Avoid heavy meals
  • Stay upright after meals

Question 4

Proportion of ulcers which are due to H.Pylori

Answer 4

○ 95% of duodenal ulcers

○ 75% of gastric ulcers

Question 5

Drugs causing GORD

Answer 5

○ NSAIDs
○ SSRIs
○ corticosteroids
○ bisphosphonates

Question 6

What is Zollinger-Ellison syndrome?

Answer 6

Rare cause of Peptic ulcer disease characterised by excessive levels of gastrin- from a gastrin secreting tumour

Question 7

Features of H Pylori infections

Answer 7

• epigastric pain
	• nausea
	• duodenal ulcers
		○ more common than gastric ulcers
		○ epigastric pain when hungry, relieved by eating
	• gastric ulcers
		○ epigastric pain worsened by eating

Question 8

What is Plummer- Vinson syndrome

Answer 8

Triad of:
• dysphagia (secondary to oesophageal webs)
• glossitis
• iron-deficiency anaemia
Treatment includes iron supplementation and dilation of the webs

Question 9

What happens during a Mallory-Weiss tear

Answer 9

Severe vomiting → painful mucosal lacerations at the gastroesophageal junction resulting in haematemesis. Common in alcoholics

Question 10

What is Boerhaave syndrome?

Answer 10

Severe vomiting → oesophageal rupture

Question 11

Presentation of H pylori

Answer 11

• Epigastric discomfort or pain
  
  • Nausea and vomiting
  • Dyspepsia
  • Bleeding causing haematemesis, “coffee ground” vomiting and melaena
  • Iron deficiency anaemia (due to constant bleeding)