GORD Flashcards
What is GORD?
inflammation of the oesophagus caused by reflux of gastric acid +/or bile.
What is GORD caused by etiologically?
Disruption of mechanisms that prevent reflux:
Lower oesophageal sphincter
Acute angle of junction
Mucosal rosette
Intra-abdominal portion of oesophagus (diaphragm acts as a sphincter)
Prolonged oesophageal acid clearance (in 50% of cases)
What is the epideiomiology of GORD?
COMMON
5-10% of adults
List 4 symptoms of GORD
Substernal/ epigastric burning discomfort or ‘heartburn’ - relieved by antacids
Waterbrash (regurgitation of gastric contents; saliva + acid)
Aspiration: may result in hoarseness, laryngitis, nocturnal cough + wheeze
Dysphagia: caused by formation of peptic stricture after long-standing reflux
List 4 signs on GORD
Usually NORMAL. Occasionally:
Epigastric tenderness
Wheeze on chest auscultation
Dysphonia
What 4 investigations should be performed for GORD?
Upper GI endoscopy, biopsy + cytological brushings: Confirms oesophagitis + excludes malignancy
Barium Swallow: to detect Hiatus hernia, Peptic stricture, Extrinsic compression of the oesophagus
CXR: NOT specific for GORD: can lead to incidental finding of a hiatus hernia (gastric bubble behind cardiac shadow)
24 hr oesophageal pH monitoring:
pH probe in lower oesophagus determines temporal relationship between Sx + oesophageal pH
What 6 strategies of conservative management are used for GORD?
Weight loss Elevating head of bed Avoid provoking factors Stop smoking Lower fat meals Avoid large meals late in the evening
What 3 forms of medical management are used for GORD?
Antacids + Alginates
H2 antagonists (e.g. ranitidine)
PPIs (e.g. lansoprazole, omeprazole)
What is surgical management used for in GORD?
Antireflux surgery if refractory to medical tx
List 6 complications of GORD
Oesophageal ulceration Peptic stricture Anaemia Barrett's oesophagus Oesophageal adenocarcinoma Associated with asthma + chronic laryngitis
What is the prognosis in GORD?
50% respond to lifestyle measures alone
In pts that require drug tx, withdrawal is often associated with relapse
20% of pts undergoing endoscopy for GORD have Barrett’s oesophagus
Why is endoscopy used in management of GORD?
Annual endoscopic surveillance: looking for Barrett’s Oesophagus
May be necessary for stricture dilation or stenting
What is a Nissen Fundoplication?
Operation to repair hiatus hernia
Fundus of the stomach wrapped around the lower oesophagus: helps reduce risk of hiatus hernia + reduce reflux
What aggravates the ‘heartburn’ pain experienced in GORD?
Lying supine
Bending
Large meals
Drinking alcohol
