GORD

Question 1

what are the risk factors for GORD?

Answer 1

lower oesophageal sphincter hypotension 
hiatus hernia 
loss of oesophageal peristaltic function 
abdominal obesity 
gastric acid hypersecretion 
overeating 
smoking and alcohol

Question 2

what are the S&S of GORD?

Answer 2

dyspepsia

• central burning chest pain
• worse on lying
• can occur at night

Acid or bile regurg

Beltching and bloating

odynophagia
- painful swallowing from oesophagitis or ulceration

noctural asthma, cough and laryngitis cause by intermittent pharyngeal reflux

Question 3

what investigations are done in GORD?

Answer 3

PPI trial - 8 weeks to check for symptom improvement

OGD

• oesophagitis
• Barrett’s oesophagus

Ambulatory pH monitoring

• nasal oesophageal catheter or wireless radiotelemetry capsule monitoring
• pH of <4 more than 4% of time is abnormal

Oesophageal manometry
- achlasia, oesophageal spasm, motility disorder

Barium swallow
- exclude other causes of dysphagia

Question 4

what are the treatment options for GORD? Give their MOA and SE’s

Answer 4

PPI i.e omeprazole 20mg, lansoprazole 20mg

• inhibits H+/K+ ATPase in parietal cells leading to reduced HCL secretion into lumen
• SE’s of abdo pain, arthralgia, hypomagnesaemia, GI infections, B12 deficiency

H2 receptor antagonist e.g cimetdine or famotidine

• Binds to H2 receptor on basolateral membrane of parietal cells, blocking histamine effects and reducing acid secretion
• SE’s of N&V, decreased saliva and breathing issues

Lifestyle changes
- weight loss, head of bed elevation, avoid late night eating and triggering foods eg caffeine, alcohol

Antacids

Surgery

• laparoscopic fundoplication, ‘Nissen’s operation’
• wrapping fundus of the stomach around the intra-abdominal oesophagus to augment high pressure zone
• only done if refractory to medical treatment, risk of aspiration pneumonia or complications arisen

Question 5

what are the complications of GORD ?

Answer 5

ulceration and haemorrhage

aspiration pneumonia

oesophageal stricture

Barrett’s oesophagus

Adenocarcinoma of oesophagus

Question 6

what is barretts oesophagus?

Answer 6

Change in the normal squamous epithelium of the oesophagus to columnar epithelium due to acid reflux.

there is interstitial metaplasia and increased goblet cells

Question 7

what is seen on endoscopy and biopsy in barrett’s oesophagus?

Answer 7

mucosa goes from pink/grey to salmon pink

histology shows metaplasia and dysplasia with irregular cells shape and irregular nuclei

Question 8

what is the management of barrett’s oesophagus?

Answer 8

PPI
surveillance
radiofrequency ablation
if dysplasia seen then oesophagectomy

Question 9

what are the types of hiatus hernia?

Answer 9

sliding HH

• 80% of hiatus hernias
• GOJ slides up into chest

Rolling HH

• 20%
• GOJ remains in abdomen but bulge of the stomach hernaites up into chest alongside oesophagus

Question 10

How can hiatus hernia be diagnosed and managed?

Answer 10

CXR
- retrocardiac air bubble or can be normal

Upper GI series shows intrathoracic stomach

CT and MRI give clear picture

Surgical repair usually by Nissens fundoplication