GORD and Hiatus Hernia Flashcards
What is GORD?
Reflux of gastric contents into the oesophagus due to a defective lower oesophageal sphincter
What are some factors which are associated with GORD?
Anything which increases intra-abdominal pressure eg, obesity, pregnancy.
Alcohol, smoking and coffee.
Drugs which relax the LOS - tricyclics, anticholinergics, nitrates, CCBs, NSAIDs.
Overeating,
Hiatus hernia,
Tight clothes,
Surgery for achalasia
What are the signs and symptoms of GORD?
Typical: Dyspepsia, sensation of acid regurgitation.
Atypical: Epigastric/chest pain, nausea, bloating, belching, globus, laryngitis, tooth erosion.
What are the alarm symptoms in GORD?
Weight loss, anaemia, dysphagia, haematemesis, melaena, persistent vomiting
What are the differential diagnosis for GORD?
Gastric ulcer, oesophageal cancer, oesophagitis, functional dyspepsia.
What are the investigations for GORD?
Trial of standard dose PPI,
Oesophagogastroduodenoscopy if alarm features, atypical or persistent disease.
Oesophageal mamometry
24hr oesophageal pH monitoring (gold standard).
What are the indications of an OGD in GORD?
Age >55,
Symptoms > 4 weeks or persisting despite treatment.
Dysphagia,
Relapsing symptoms,
Weight loss
What are the types of hiatus hernia?
Sliding - GOJ above diaphragm (more common)
Rolling/paraoesphageal - GOJ remains below diaphragm and separate part of stomach herniates through
What are the risk factors for a hiatus hernia?
Obesity and increased intra-abdominal pressure eg, ascites or multiparity.
What are the features of a hiatus hernia?
Heartburn, dysphagia, regurgitation, chest pain
What are the investigations for a hiatus hernia?
Barrium swallow is most sensitive however due to nature of symptoms most are diagnosied via OGD
What is the management of a hiatus hernia?
Conservative management for all.
Medical management: 4-8 weeks of PPI
Surgical management: For rolling hernias. Involves Nussen’s fundoplication
What are the lifestyle measurements for hiatus hernias and GORD?
Reduce tea, coffee, and alcohol.
Weight loss,
Avoid smoking,
Smaller and lighter meals.
Avoid heavy meals before bed.
Stay upright after meals
WHat is the management of GORD?
Initially - 8 weeks of PPI eg, omeprazole 20mg OD.
If fails to respond then give high dose PPI and endoscopy.
If responds then give lowest dose possible which still controls symptoms
What are the indications for surgery in GORD?
Failure to respond to medical therapy,
Patient preference to avoid long term medication.
Complications with GORD
What is the management of endoscopically proven oesophagitis?
PPI for 1-2 months.
If responds then low dose treatment as required.
If no response then double dose for 1 months
What are the complications of GORD?
Oesophagitis,
Ulcers,
Anaemia,
Benign strictures,
Barret’s oesophagus,
Oesophageal carcinoma
Which patients should get an urgent cancer referral for endoscopy?
All patients with dysphagia,
Patients with upper abdo mass suspicious og gastric cancer.
Pagents >=55 years with weight loss AND any of: upper abdo mass, reflux or dyspepsia
What are the investigations for H.pylori?
Initial - Urea breath test (not a rapid urease test) or stool antigen testing.
Test of cure - not indicated if symptoms have resolved however if persist then do urea breath test (need to be 4 weeks free of antimicrobials and 2 weeks free of PPIs).
What are other possible investigations for H. pylori?
Stool antigen testing,
Urea breath test,
H pylori antibody testing,
Rapid urease test performed during endoscopy (CLO test)
What is Zollinger Ellison Syndrome?
Condition where a duodenal or pancreatic tumour secretes gastrin. Gastrin is a hormone which stimulates acid secretion.
What is dyspepsia?
Pain/discomfort in upper abdomen
