GORD and Dysmotility Flashcards
What are some of the main causes of GORD?
Incompetent LOS
Poor oesophageal clearance
Barrier function/visceral sensitivity
What are some of the symptoms of GORD?
Heartburn - aggregated by lying down after a meal (promotes acid exposure) Acid Refluc Water brash (excessive salivation) Dysphagia Odynophagia
Weight loss
Coughing - nocturnal cough/asthma
What is Odynophagia?
Pain when swallowing
What investigations would you do in GORD?
Endoscopy - to see if Barrett’s or GORD, if GORD need to have symptoms for > 4 weeks
Ba swallow
Oesophageal manometry & pH studies
Nuclear studies
What is Dyspepsia?
Dyspepsia, also known as indigestion or upset stomach, is a term that describes discomfort or pain in the upper abdomen. It is not a disease. Dyspepsia is a group of symptoms which often include bloating, nausea and burping.
What is dysphasia?
Difficulty swallowing
What is the 5 year survival rate of oesophageal adenocarcinoma?
5-10% 5 year survival rate
Is Barrett’s or oesophagitis reversible?
Oesophagitis - yes
Barrett’s - Not really
What is the basic management of GORD?
Symtom relief
Healing Oesophagitis
Prevent complications
What lifestyle modifications would you recommend to someone with GORD?
Stop smoking
Lose weight if obese
Prob up the bed
Avoid provoking factors
What are antacids and name examples?
Symptomatic relief
No healing or prevention benefit
E.g Gaviscon
Describe H2 antagonists, mechanism?
Competitive antagonists of histamine at the parietal cells H2 receptor. Reduced gastric acid production (less effective than PPI)
Describe some examples of H2 antagonists?
Ranitidine
Cimetidine
Describe the mechanism of PPIs?
Irreversibly blocking the H+/K+ ATPase of the gastric parietal cells. Inhibiting acid secretion. PPIs are pro-drugs activated only in the acidic environment
Describe some examples of PPIs?
Omeprazole
Lansoprazole
Are PPIs or H2 antagonists better at symptomatic relief and healing effect?
PPIs are better
Describe surgery (endoscopic fundoplication) in GORD?
Controls the symptoms in most patients
Heals the oesophagitis
Young patients more common
Only in severe/unresponsive disease
What 2 types of hiatus hernia can you get?
Sliding hiatus hernia
Parasoohgeal hiatus hernia
What is gastroparesis?
Delayed gastric emptying
No physical obstruction
What are the symptoms of gastroparesis?
Feeling of fullness
Nausea
Vomiting
Weight loss
Upper abdominal pain
What can be some causes of gastroparesis?
Idiopathic Diabetes mellitus Cannabis Medication - opiates Systemic diseases - systemic sclerosis
What is Achalasia?
Achalasia is a serious condition that affects your esophagus. The lower esophageal sphincter (LES) is a valve that closes off the esophagus from the stomach. If you have achalasia, your LES fails to open up during swallowing, which it’s supposed to do. This leads to a backup of food within your oesophagus.
