GORD and Barrett's Oesophagus Flashcards
What are the anti-reflux defences?
Lower Oesophageal sphincter
Angle of his
Mucosal flap and folds
Diaphragm
Peristalsis - clean reflux
Bicarbonate - alkali in fsaliva
What is the pathophysiology behind GORD?
Poor oesophageal peristalsis
Incompetent LOS - relax inappropriately
Hiatus hernia - stomach herniating through diaphrahm, obliterating angle of his
Delayed gastric emptying
What factors can contribute to GORD?
Pregnancy
Obesity
Diet (incl. alcohol, coffee)/ Big meals
Smoking etc.
NSAIDs - gastritis more than GORD
Systemic sclerosis a.k.a. scleroedema - esp CREST synd.
Achalasia - acquired disease causing dilated, dysfunctional oesophagus
What are the symptoms of GORD?
Dyspepsia i.e. heartburn/epigastric or retrosternal pain
- Aggravations = position (lying down), diet
- Relief = antacids/alkali/milk
Regurgitation, i.e. food/acid in mouth
Cough/aspiration
What are the alarm symptoms of GORD?
Haematemesis/Malaena or Anaemia
Anorexia or Weight loss
Dysphagia - inability to swallow
Chest symptoms e.g. cough, hoarseness, pneumonia
- these suggest aspiration
- not alarm, but require investigation
What investigations should be done for suspected GORD?
Trial of PPIs for young pations not at risk of cancer
- 2 months high dose, then reduce if symptoms subside
? FBC - to exclude anaemia
? H pylori testing
Endoscopy if alarm symptoms or onset >55y/o
- look for Barrett’s Cancer or predisposing factors
Others, e.g. for resistant GORD:
- Barium swallow - look for predisposing factors
- pH monitoring and mamometry = exclude dysfunction
How to treat GORD?
Lifestyle interventions
Drugs - Antacids - Acid suppressors [] PPIs [] H2 receptor antagonists
Eradication of H pylori
Surgery e.g. for hernia
What are the side effects of PPIs?
Impairs clopidogrel (an anti clotting drug)
What are the side effects of H2 receptor antagonists?
Diarrhoea, heartburn, reduced liver function
What is Barrett’s oesophagus?
Intestinal columnar metaplasia of the oesophagus with potential of transformation to adenocarcinoma (maligancy tumour of glandular structure)
What are the pathophysiology stages of barrett’s?
1 - erosive oesophagitis which damages epithelium
2 - metaplasia occurs during repair
3 - dysplasia occurs (abnormality in cell prolif.)
4 - neoplasia (adenocarcinoma)
What treatments can be done for high grade dysplasia due to Barrett’s oesophagus?
Ablation - burn off dysplastic epithelium with hope of squamous epithelium recolonising
Surgery - oesophageal resection
