GORD and hiatus hernia

Question 1

What is GORD?

Answer 1

Symptoms or complications resulting from the reflux of gastric contents into the oesophagus or beyond, into the oral cavity (including larynx) or lung’.

Question 2

What are symptoms of GORD?

Answer 2

Heartburn: retrosternal pain after meals/lying down/straining

Belching
Acid and water brash
Odynophagia
Dysphagia

Noctural asthma
Chronic cough

Question 3

What are risk factors for GORD?

Answer 3

Obesity
Smoking and alcohol
Age
Hiatus hernia
Oesophageal dysmotility e.g. systemic sclerosis
Delayed gastric emptying
Gastric acid hypersecretion
Medications e.g. nitrates, anti Ach, antidepressants

Question 4

What are differentials for GORD?

Answer 4

• Peptic ulcer disease
  
  • Gastritis
  • Oesophagitis
  • Gastroparesis

Question 5

What are investigations for GORD?

Answer 5

Do an endoscopy if ALARMS symptoms:
Anaemia, loss of weight, anorexia, recent onset/progressive symptoms, melaena/haematemesis, swallowing difficulty

If -ve, consider manometry with 24 hour pH monitoring

Question 6

What is management of GORD?

Answer 6

Lifestyle: smoking, weight, diet…

Drugs: antacid (Gaviscon)
PPI: 1-2 months, then alter dose as per response.

H2RA or prokinetic can be trialled if doesn’t work

Question 7

What surgery can be done for GORD?

Answer 7

Nissen fundoplication: if refractory to medications.

The fundus of the stomach is wrapped around the lower part of the oesophagus to improve valve mechanism.

Question 8

What are complications of GORD?

Answer 8

• Oesophagitis
• Ulcers
• Benign oesophageal stricture
Barrett’s oesophagus - pre-malignant