GORD

Question 1

What is GORD?

Answer 1

• acid from stomach refluxes through LOS and irritates lining of oesophagus

Question 2

What are the causes of GORD?

Answer 2

• LOS hypotension
• Hiatus hernia
• Oesophageal dysmotility
• Obesity
• Pregnancy
• Gastric acid hypersecretion
• smoking, alcohol
• H.pylori

Question 3

What are the Sx of GORD?

Answer 3

• Heartburn - after meals and worse when lying down or bending forward
• Burping
• Dyspepsia
• acid/water brash
• odynophagia, dysphagia
• epigastric pain
• bloating
• hoarse voice
• teeth erosions

Question 4

What are the red flag features indicative of urgent referral (2 week wait) for OGD?

Answer 4

• Dysphagia at any age gets a two week wait referral
• weight loss >55 + 1 of;
  
  • epigastric pain
  • reflux
  • dyspepsia

Question 5

What Ix would you order for GORD?

Answer 5

• Clnically diagnosed
• pH monitoring
  
  • 24-hour pH monitoring:
  • Wireless pH capsules testing
• OGD

Question 6

What is the Mx for GORD?

Answer 6

Lifestyle

• weight loss
• smoking cessation
• small, regular meals
• reduce caffeine, spicy food, alcohol, hot drinks
• avoid eating <3hrs before bed

Drugs

• Antacids
  
  • Gaviscon
• PPI
• H2RA
  
  • Ranitidine

Surgery

• Endoscopic surveillance

for patients with metaplasia (but not dysplasia) endoscopy is recommended every 3-5 years

• If dysplasia:

endoscopic mucosal resection

radiofrequency ablation

• Nissin fundoplication

Question 7

What is the Cx of GORD?

Answer 7

• Barrett’s Oesophagus
• erosions
• strcuture

Question 8

What is Barretts oesophagus?

Answer 8

• Metaplasia of nonkeratinized stratified squamous epithelium to nonciliated columnar epithelium

Question 9

What is BO high risk of?

Answer 9

• adenocarcinoma

Question 10

How do you monitor BO?

Answer 10

• monitor - regular endoscopy
• PPI
• Ablation treatment
  
  • photodynamic therapy
  • laser therapy
  • cryotherapy

Question 11

What are the differentials for GORD?

Answer 11

• Functional heartburn
• Achalasia (failed relaxation of LOS)
• Eosinophilic oesophagitis
• Pericarditis
• Ischaemic heart disease
• Peptic ulcer disease
• Malignancy

Question 12

What classification is used to grade severity of Oesophagitis?

Answer 12

• Los angeles classification

Question 13

What is the Los Angeles Classification?

Answer 13

• Grade A: ≥1 mucosal break, each ≤ 5mm
• Grade B: ≥1 mucosal break > 5mm. Not continuous between top of mucosal folds.
• Grade C: ≥1 mucosal break, continuous between top of mucosal folds, not circumferential
• Grade D: mucosal breaks involving more than three quarters of luminal circumference.

Question 14

What are the long term effects of omeprazole?

Answer 14

• hyponatraemia, hypomagnasaemia
• osteoporosis → increased risk of fractures
• microscopic colitis
• increased risk of Clostridium difficile infections