GORD Flashcards
What is GORD?
A common disease and is caused by reflux of stomach contents (acid +/- bile) causing troublesome symptoms and/or complications.
Complications of GORD.
Oesophagitis
Benign oesophageal strictures
Barrett’s oesophagus
Causes of GORD.
Lower oesophageal sphincter hypotension
Hiatus hernia
Oesophageal dysmotility like in systemic sclerosis
Obesity
Gastric acid hypersecretion
Delayed gastric emptying
Smoking
Alcohol
Pregnancy
Drugs like tricyclics, anticholinergics and nitrates
Symptoms of GORD.
Heartburn after meals, lying, stooping, or straining. This is relieved by antacids.
Belching
Acid brash
Waterbrash
Odynophagia
Extra-oesophageal symptoms of GORD.
Nocturnal asthma
Chronic cough
Laryngitis (hoarseness and throat clearing)
Sinusitis
Complications of GORD.
Oesophagitis
Ulcers
Benign strictures
Iron-deficiency
Barrett’s oesophagus
Differentials of GORD.
Oesophagitis from corrosives
NSAIDs
Herpes
Candida
Duodenal ulcers or gastric ulcers.
Cancers
Non-ulcer dyspepsia
Oesophageal spasm
Cardiac disease
Investigations of GORD.
Endoscopy if dysphagia or if > 55 years old with ALARM symptoms, ror with treatment-refractory dyspepsia.
24h oesophageal pH monitoring +/- manometry can help diagnose GORD if endoscopy is normal.
Lifestyle treatment of GORD.
Weight loss
Smoking cessation
Small and regular meals
Reduce hot drinks, alcohol, citrus fruits, tomatoes, onions, fizzy drinks, spicy foods, caffeine and chocolate
Avoid eating less than 3 hours before bed
Raise the bed head
Pharmacological treatment of GORD.
Antacids like Gaviscon
PPi
If there are refractory symptoms add an H2 blocker and/or try twice daily PPi.
Avoid drugs affecting oesophageal motility like nitrates, anticholinergics, CCBs, or that damage the mucosa like K+ salts, bisphosphonates and NSAIDs.
Surgery in GORD.
Laraoscopic Nissen fundoplication
Laparoscopic insertion of a magnetic bead band
Radiofrequency-induced hypertrophy
These all aim to increase resting lower oesophageal sphincter pressure.
Indications of surgery in GORD.
Severe GORD if drugs are not working.
This needs to be confirmed by pH monitoring or manometry first.
Types of hiatus hernia.
Sliding hiatus hernia
Paraoesophageal hernia (rolling hiatus hernia)
Explain sliding hiatus hernia.
80% of hiatus hernia are sliding.
The gastro-oesophageal junction slides up into the chest.
Acid reflux often happens as the lower oesophageal sphincter becomes less competent in many cases.
Explain rolling hiatus hernia.
20% of all hiatus hernia.
The gastro-oesophageal junction remains in the abdomen but a bulge of stomach herniates up into the chest alongside the oesophagus.
As the gastro-oesophageal junction still remains intact in thsi case, GORD is less common.
