GORD Flashcards
What is GORD?
A condition where gastric acid from the stomach leaks up into the oesophagus
Epidemilogy
Affecting around a quarter of the western population.
Around 4% of primary care appointments
M 2:1 Women
Pathophysiology
The lower oesophageal sphincter (LOS) controls passage of food form oesophagus to stomach.
It is normal for episodic LOS relaxation to occur, however in GORD the episodes become more frequent and there is reflux of gastric content.
The acidic gastric content result in pain and mucosal damage in oesophagus.
Risk factors
Age
Obesity
Male gender
Alcohol
Smoking
Caffeinated drinks
Fatty and spicy foods
Clinical features
Chest pain usually described as burning retrosternal sensation
Worse after meal, lying down, bending over or straining.
The pain is usually relieved by antacids.
There might also be belching, odynophagia, chronic cough or a nocturnal cough.
Red flags of GORD
Dysphagia
Weight loss
Early satiety
Malaise
Loss of appetite
These red flags symptoms indicates there might be underlying malignancy.
Examination findings
Typically unremarkable
What classification is used for GORD?
Los Angeles classification
Explain Los Angeles classification of reflux.
Used to grade reflux oesophagitis based on severity from the endoscopic findings of mucosal breaks in the distal oesophagus.
Grade A - breaks 5 mm or less
Grade B - >5 mm
Grade C - Breaks extending between the tops of 2 or more mucosal folds but <75 of circumference
Grade D - Circumferential breaks (75% or more)
Dx
Malignancy
Peptic ulceration
Oesophageal motility disorders
Oesophagitis
Cardiac/Biliary disease
Ix
Clinical diagnosis with good history and resolution of symptoms after a trial of PPi.
When should urgent endoscopy be done?
Suspecting upper GI malignancy in…
Patients with dysphagia
Any patient >55yo with weight loss and upper abdo pai, dyspepsia or reflux.
When should an upper GI endoscopy be done?
Exclude malignancy and investigate complications of reflux such as oesophagitis, stricturing and Barrett’s.
Red flags of GI malignancy
New onset symptoms or worsening despite PPis.
What is the gold standard in diagnosing GORD.
24h pH monitoring.
This is required for patients in whom medical treatment fails and surgery is being considered.
It should be combined with oesophageal manometry to exclude oesophageal dysmotility.
Explain pH monitoring studies.
The amount of time acid is present in the oesophagus
Correlation between the presence of acid and the patient’s symptoms
This produces an algorithmic score called DeMeester score
Give specific examples of fundoplication
They usually differ in direction and completeness of the wrap.
Nissen’s = posterior 360 fundoplication
Partial anterior approach
