GORD and Ulcers Flashcards
What is peptic ulcer disease?
Peptic ulcer disease:
- Upper GI disorder due to erosion of the mucosal layer of the GI tract occurring in areas exposed to acid and pepsin.
Which site is commonly affected in peptic ulcer disease?
In peptic ulcer disease the most common ulceration site is in the lesser curvature of the stomach and in the proximal duodenum
Gastroesophageal reflux disease
Gastroesophageal reflux disease:
* Disease characterized by acid reflux into the oesophagus
* Symptoms: Heartburn- uncomfrotable burning sensation behind the breastbone. (retrostenal pain), regurgitation, sore throat, acid brash, waterbrash(watery sensation in the mouth), nocturnal cough (exacerbation of ashtma)
* Complications:
* Dysphagia, chest pain, oesophageal erosions, oesophageal ulcer, strictures (narrowing of the oesophagus) caused by inflammation, alterations of peristaltic movement.
* Increased risk of oesophageal cancer and Barrett’s oesophagus.
* Risk factors: Obesity, hiatus hernia, pregnancy, GI motility disorders (delayed gastric emptying)
* Behaviours that can worsen it: Smoking, eating large meals, eating late at night, fatty foods, fried foods, alcohol, caffeine, medications (e.g. aspirin)
* Treatment:
* Antacids (neutralize acids)
* Histamine H2 antagonists (target H2 receptors on parietal cells)
* Proton pump inhibitors (irreversibly block the action of the H+/ K+- ATPASE on parietal cells)
* Alginates (Seaweed based, form a protective layer over stomach contents)
Which drugs promote gut healing?
Drugs that promote gut healing:
* Misoprostol (promotes healing of NSAID-associated ulcers, acts on G-protein-coupled EP receptors in gastric mucosa, increases mucus and bicarbonate production, reduces acid secretion)
* Sucralfate (forms a protective coating over ulcers and erosions)
* Bismuth chelate (toxic to H.pylori)
Gastroesophageal reflux disease treatment
Gastroesophageal reflux disease treatment
* Antacids (neutralize acids)
* Histamine H2 antagonists (target H2 receptors on parietal cells)
* Proton pump inhibitors (irreversibly block the action of the H+/ K+- ATPASE on parietal cells)
* Alginates (Seaweed based, form a protective layer over stomach contents)
Gastroesophageal reflux disease symptoms
Gastroesophageal reflux disease symptoms
* Heartburn- uncomfortable burning sensation behind the breastbone (retrostenal pain),
* regurgitation,
* sore throat,
* acid brash,
* waterbrash(watery sensation in the mouth),
* nocturnal cough (exacerbation of ashtma)
* increased salivation
* shortness of breath
Gastroesophageal reflux disease complications
Gastroesophageal reflux disease complications
* Dysphagia,
* chest pain,
* oesophageal erosions,
* oesophageal ulcer,
* strictures (narrowing of the oesophagus) caused by inflammation,
* alterations of peristaltic movement.
* Increased risk of oesophageal cancer and Barrett’s oesophagus.
Gastroesophageal reflux disease risk factors
Gastroesophageal reflux disease risk factors
* Obesity
* hiatus hernia,
* pregnancy,
* GI motility disorders (delayed gastric emptying)
Behaviours that can worsen gastroesophageal reflux disease:
Behaviours that can worsen gastroesophageal reflux disease:
* Smoking,
* eating large meals,
* eating late at night,
* fatty foods,
* fried foods,
* alcohol,
* caffeine,
* medications (e.g. aspirin, calcium channel blockers, nitrates)
What is Gastroesophageal reflux disease?
Gastroesophageal reflux disease:
* Disease characterized by acid reflux into the oesophagus
* the backflow of stomach acid (and bile) into the oesophagus.
What is Normal gastro-oesophageal reflux (GOR)?
Normal gastro-oesophageal reflux (GOR) is the passage of gastric contents into the oesophagus. It is considered physiological in infants when symptoms are absent or not troublesome.
What is GORD in children?
Gastro-oesophageal reflux disease (GORD) in children is the presence of troublesome symptoms or complications arising from GOR.
Frequent effortless regurgitation of feeds is common and __________ in infants less than 1 year of age. It may be ____________to differentiate between gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD) as there is no reliable diagnostic test.
Frequent effortless regurgitation of feeds is common and normal in infants less than 1 year of age. It may be difficult to differentiate between gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD) as there is no reliable diagnostic test.
Why are children <1 year susceptible to GOR?
Children< 1 year are susceptible to GOR due to several anatomical and physiological features:
* They have delayed gastric emptying
* They have a short, narrow oesophagus
* Their lower oesophageal sphincter is slightly above the diaphragm
When are children more at risk for developing GORD?
Children with increased risk for developing GORD if they have/are:
* Cystic fibrosis
* severe neurological impairment
* gastro-oesophageal abnormalities
* premature
* Parental history of heartburn or acid regurgitation.
* Obesity.
* Hiatus hernia.
* History of congenital diaphragmatic hernia (repaired) or congenital oesophageal atresia (repaired).
* Neurodisability
When should GORD be suspected in children?
GORD should be suspected in children with either (but usually both) of the following:
* Frequent and troublesome regurgitation or vomiting (which may occur up to 2 hours after feeding).
* Frequent and troublesome crying, irritability, or back-arching during or after feeding, or feeding or food refusal (despite being willing to suck on a dummy).
* distressed behaviour,
* hoarseness,
* unexplained
* feeding difficulties,
* faltering growth
* chronic cough
* A single episode of pneumonia.
GORD should be suspected in children over 1 year who present with heartburn, retrosternal pain, or epigastric pain.
GORD in children: when should same day admission be arranged?
Same-day admission should be arranged if the child has:
Haematemesis (vomiting blood) (not caused by swallowed blood from a nosebleed or ingested from a cracked maternal nipple).
Melaena (black stool, symptom of internal bleeding).
Dysphagia.
When should there be specialist assessment by a paediatrician or paediatric gastroenterologist?
Specialist assessment by a paediatrician or paediatric gastroenterologist should be arranged if there is:
An uncertain diagnosis or ‘red flag’ symptoms which suggest a more serious condition.
Persistent faltering growth associated with regurgitation.
Suspected complications, such as recurrent aspiration pneumonia, or unexplained apnoeas.
Which complications may arise in children with GORD?
Complications that may occur in children with GORD include:
* Anaemia
* Dysphagia (difficulty in swallowing)
* Respiratory symptoms (such as cough, wheeze, asthma, or reactive airways disease)
Plus other symptoms
* Sleeping difficulties
* Dental erosion.
* Failure to thrive
* Reflux oesophagitis
* Aspiration pneumonia
* Acute otis media
GORD infant/children treatment
GORD infant/children treatment:
* Children who have frequent regurgitation only: parents and carers reassured that symptoms are likely to improve over time.
* Breastfed infants with suspected GORD: 1–2 week trial of Gaviscon® Infant
* Formula-fed infants with suspected GORD: sequential 1–2 week trial of:
* reduction of the volume of feeds,
* more frequent feeds,
* thickened feeds (for example Instant Carobel®)
* Gaviscon® Infant.
For breastfed and formula-fed infants:
If treatment with Gaviscon® Infant is successful, continue. Stop treatment every 2 weeks to see if symptoms improve and treatment can be stopped.
If treatment with Gaviscon® Infant is not successful, a 4–week trial of omeprazole or H2 receptor antagonist (H2RA) may be considered.
* If symptoms still persist, the child should be referred for specialist assessment.
* For children aged 1–2 years of age with suspected GORD, a 4–week trial of omeprazole or H2RA may be considered.
If symptoms still persist, the child should be referred for specialist assessment.
Red flags: indicative of non-GORD issues
Red flags: indicative of non-GORD issues
* Vomiting –
* bilious
* bloodstained
* very forceful
onset occurs > 6m
* Respiratory symptoms
* Diarrhoea
* Blood in stool
* Lethargy
* Fever
* Abnormal abdominal examination
* Neuro/developmental problems e.g bulging fontanelle
* Dysuria
* High risk of atopy
What is there usually misdiagnosis of in children?
Misdiagnosis between delayed milk protein allergy and GORD in children
What do studies show about elevated pHlevels in the lower oesophageal sphincter?
Studies show elevation of pH in lower oesophagus is therapeutically advantageous..
What might future GORD interventions include?
Future GORD interventions may include pro-motility drugs
Why are proton pump inhibitors the current drug of choice for GORD treatment?
Proton pump inhibitors current drug of choice due to efficacy over H2RAs
How is peptic ulcer disease diagnosed?
Peptic ulcer disease is diagnosed by endoscopy or H.pyloribacter testing
Where are CCK2 receptors found?
CCK2 receptors are found on the parietal cells
Which receptors are found on the parietal cells?
CCK2 and H2 receptors are found on the parietal cells
_________ ________ is the target of non-steroidal antiinflammatory drugs.
Cyclo-oxygenase is the target of non-steroidal antiinflammatory drugs.
What are the two main types of peptic ulcer disease?
Two types of peptic ulcer disease:
* Gastric ulcer: Defective ability of gastric mucosa to protect and repair itself
* Duodenal ulcer: Hypersecretion of gastric acid → erosion of mucosa in duodenum
