GORD + Barrett's Oesophagus

Question 1

What is GORD?

Answer 1

• Regurgitation of acidic gastric contents into the lower oesophagus
• The acid injures the squamous epithelium lining the oesophagus, causing inflammation

Question 2

What is Barrett’s oesophagus?

Answer 2

• Metaplasia
• Change in cell type to adapt to the changing environment
• In this case, the change in pH so the oesophagus is better suited for the greater acidity (squamous epithelium to columnar epithelium)
• Seen in long term GORD

Question 3

What are the risk factors of GORD?

Answer 3

• Obesity and pregnancy (both increase abdominal pressure)
• Smoking
• Alcohol
• Coffee
• Hiatus Hernia
• NSAID use

Question 4

What are the possible causes of GORD?

Answer 4

• Lower oesophageal sphincter weakness
• Hiatus hernia
• Oesophageal dysmotility
• Gastric hypertension
• H.Pylori

Question 5

What are the clinical features of GORD?

Answer 5

• Heart burn (symptoms of oesophagitis)
• Waterbrash (acid in mouth)
• Haematemesis and Malaena (due to peptic ulcer)
• Progressive dysphagia

Question 6

What are the investigations in suspected GORD?

Answer 6

=> 24 hour oesophageal pH monitoring
GOLD STANDARD. Usually used when endoscopy turns out normal

=> Endoscopy
only indicated in those > 55 years or with ALARMS symptoms

Question 7

What are the ALARMS symptoms?

Answer 7

A - Anaemia
L - Loss of weight
A - Anorexia
R - Recent onset/ progressive symptoms
M - Malaena/ haematemesis 
S - Swallowing difficulties

Question 8

What is the management of GORD?

Answer 8

=> Lifestyle + Antacids

=> Base management on endoscopy

=> Endoscopically proven oesophagitis:

• Start on a PPI for 1-2 months
• If there is response, continue on the low dose taken when needed
• If no response, the double the dose of PPI for 1 month

=> Endoscopically negative for reflux disease:

• Full dose PPI for 1 month
• If response, offer low dose treatment taken when needed
• If no response, start histamine antagonists

Question 9

What lifestyle advice is given to those with GORD?

Answer 9

• Lose weight
• Smoking cessation
• Reduce alcohol consumption
• Avoid eating less than 3 hours before bed

Question 10

What is the surgical option of management of GORD?

Answer 10

Laproscopic Nissen Fundoplication

Question 11

What are the main complications of GORD?

Answer 11

• Oesophagitis
• Barrett’s oesophagus
• Oesophageal carcinoma
• Ulcers
• Anaemia
• Benign strictures

Question 12

What is the MOA and major side affects of Antacids?

Answer 12

=> MOA:

• Neutralise any excess acid
• Taken to relieve symptoms rather than to treat condition

=> Side effects:

• Diarrhoea or constipation
• Nausea or vomiting
• Stomach cramps

Question 13

What is the MOA and major side effects of Histamine Antagonists?

Answer 13

=> MOA:
- Act of H2 receptors of parietal cells, reducing amount of acid production by blocking action of histamine

=> Side effects - depend on the type of histamine antagonist:
Ranitidine and Famotidine - headaches
Cimetidine - diarrhoea, gynacosmatia, dizziness
Nizatidine - side effects rare

Question 14

What is the MOA and major side effects of proton Pump Inhibitors?

Answer 14

=> MOA:

• Work irreversibly by stopping activity of H+/K+ pump on parietal cells
• Causing a reduction in gastric acid levels

=> Side effects:

• Diarrhoea or constipation
• Nausea or vomiting
• Headaches
• Abdominal pain

Question 15

What is the management of Barrett’s oesophagus?

Answer 15

• Endoscopic surveillance and biopsy - once ever 3-5 years for those with metaplasia
• High dose proton pump inhibitor

=> Any evidence of dysplasia:

• Endoscopic resection
• Radio frequency ablation