GORD and Barrett's oesophagus Flashcards
what can prolonged GORD (reflux) cause?
1) oesophagitis
2) benign oesophageal stricutre
3) Barrett’s oesophagus (pre-malignant)
what can be the causes of GORD? (11)
Alcohol Smoking Pregnancy Obesity Drugs = tricylcic, anticholinergics and nitrates H. Pylori Delayed gastric emptying Gastric acid hypersecretion Lower oesaphageal sphincter hypotension Oesophageal dysmotility (e.g. systemic sclerosis) Hiatus Hernia
what is GERD?
retrograde flow of stomach contents into the oesophagus which causes irritation to epithelial linings.
what are risk factors for GERD? (5)
- Smoking
- Alcohol consumption
- Stress
- Obesity
- Anatomical abnormalities of the esophagogastric junction (e.g. hiatal hernia)
what are the symptoms of GERD? (10)
- Retrosternal burning pain (heartburn) – worsens while lying down at night and after eating
- Pressure sensation in the chest
- Belching, regurgitation
- Chronic non-productive cough and nocturnal cough
- Halitosis
- Dysphagia
- Feeling of increased pressure
- Triggers:
- Supine position
- Smoking
what are oesophageal symptoms of GERD? (5)
- Heartburn (burning, retrosternal discomfort after meals, lying, stooping, or straining, relieved by antacids)
- Belching
- Acid brash (acid or bile regurgitation)
- Water brash (increase salivation: my mouth fills with saliva)
- Odynophagia (painful swallowing e.g. from oesophagitis or ulceration)
What are extra-oesophageal symptoms of GERD? (4)
- Nocturnal asthma
- Chronic cough
- Laryngitis (hoarseness, throat clearing)
- Sinusitis • Nocturnal asthma
- Chronic cough
- Laryngitis (hoarseness, throat clearing)
- Sinusitis
what are the indications for upper GI endoscopy? (5)
• Age > 55 years • Symptoms > 4 weeks or persistent symptoms despite treatment • Dysphagia • Relapsing symptoms • Weight loss ALARM symptoms
what are the lifestyle treatments for GERD?
- Weight loss
- Smoking cessation
- Small, regular meals
- Reduce hot drinks
- Alcohol
- Citrus fruits
- Tomatoes
- Onions
- Fizzy drinks
- Spicy foods
- Caffeine
- Chocolate
- Avoid eating <3h before bed
- Raise the bed head
- Normalise body weight
what drugs can be given to treat GERD?
- Antacids, e.g. magnesium trisilicate mixture
- Alginates e.g. Gaviscon relieve symptoms
- Add an H2 blocker and/or twice daily PPI
- Avoid drugs affecting oesophageal motility (nitrates, anticholinergics, Ca2+ channel blockers – relax the lower sphincter)
- Or that damage mucosa (NSAIDs, K+ salt, bisphosphonates
- Standard dose of PPI for at least 8 weeks.
what drugs affect oesophageal motility and how do they affect it? (3)
They relax the lower sphincter.
- Nitrates
- Anticholinergics
- Ca2+ channel blockers
what drugs damage the mucosa? (3)
- NSAIDs
- K+ salts
- Bisphonates
what does surgery aim to do?
increase the resting lower oesophageal sphincter pressure
what are the types of surgeries you can do?
• laparoscopic Niseen fundoplication, or novel options including laparoscopic insertion of amagentic bead band or radiofrequency-induced hypertrophy)
when do you consider surgery?
in severe GORD (confirm by pH monitoring / manomotery)
or if drugs not working
what is a hiatus hernia and who is it most common in?
in obese women over 50 years old.
most are asymptomatic but pateints with large hernias may develo GORD.
Gastro-oesophageal junction slides up into the chest. Acid reflux often happens as the lower oesophageal sphincter becomes less competent in many cases.
what are the types of hiatus hernias?
Type I:
Symptoms of GERD
Type II, III, IV:
Epigastric/substernal pain
Early satiety
Symptoms of GERD can occur
what is the gold standard investigations for upper GI tract?
Endoscopy
what are blood tests used for?
A full blood count shows anaemia to be detected, and liver tests and serum lipase may be useful if hepatobiliary or pancreatic disease is suspected. In the last case ultrasonography is also recommended
what’s an example of non-invasice H Pylori test?
Such as the C urea breath test, can be used as an indirect “peptic ulcer test”.
what is the pathophysiology of Barrett’s oesophagus?
- Reflux esophagitis -> stomach acid damages squamous epithethelium -> squamous epithelium becomes replaced by columnar epithelium and goblet cells (intestinal metaplasia, Barett’s metaplasia)
- The physiological transformation zone (Z-line) between squamous and columnar epitheleium is shifted upwards.
what is the management of Barrett’s oesophagus?
- Medical treatment with PPIs
- Endoscopy with four-quadrant biopsies at every 2cm of the suspicious area (salmon coloured mucosa)
- If low-grade dysplasia – endoscopic therapy of mucosal irregularities
- Endoscopic therapy of mucosal irregularities.
what are the ALARM symptoms?
Anaemia (iron deficiency) Loss of weight Anorexia Recent onset/progressive symptoms Melana / haemoptysis Swalling difficulty
what is dysphagia
characterised by inability to swallow or difficulty swallowing.
what is achalasia?
failure of the lower oesophageal sphincter to relax caused by a degeneration of inhibitory neurons within the oesophageal wall.
