GORD, Barrett's Oesophagus, Oesophagitis Flashcards
What does GORD stand for?
Gastro-oesophageal Reflux Disease
What are causes of GORD?
Incompetent LOS Poor oesophageal clearance or barrier function Visceral sesntivity Increased abdominal pressure Gastric acid hypersecretion Slow gastric emptying Overating Surgery in achalasia Drugs Systemic sclerosis
What are causes of increased abdominal pressure increasing risk of GORD?
Obesity
Pregnancy
What are the major risk factors for GORD?
Smoking
Alcohol
Weight
Which drugs can cause GORD?
Tricyclics
Anticholinergics
Nitrates
What is associated with systemic sclerosis in the GORD context?
H. pylori
What is the pathological mechanism behind GORD?
Ulceration due to exposure
GORD is graded according to?
Erosion
What are the 4 grades of GORD?
Tiny erosion
> 5 mm
<75% affected
All affected
How does GORD present?
Heartburn Acid reflux Water brash (hyper-salivation) Dysphagia Odynophagia (pain on swallowing) Weight loss Epigastric pain (mimic cardiac) Hoarseness Cough Reflux bronchitis lying flat
How do you investigate GORD?
Endoscopy Barium swallow Oesophageal manometry pH studies Nuclear studies
Where are possible complications of GORD?
Barrett's -> Oesophageal carinoma Benign oesophageal stricture (Schatzki's rink) Oesophagitis Gastroparesis Achalasia Hiatus hernia
What is gastroparesis?
Delayed gastric emptying without physical obstruction
What are symptoms of gastroparesis?
Feeling full / bloated Nausea Vomiting (food fear) Weight loss Epigastric pain Feeling bloated
What are causes of gastroparesis?
Idiopathic DM Cannabis Medication Systemic disease (systemic sclerosis)
Which medications can cause gastroparesis?
Opiates
Anticholinergics
How do you investigate gastroparesis?
Gastric emptying studies
How do you manage gastroparesis?
Remove provokers Liquid/sloppy diet Eat little and often Pro-motility agents Gastric pacemaker
How do you manage GORD?
If no erosion manage symptoms Lifestyle Antacid PPI Surgery
Which antacids can be given for GORD?
Magnesium trisillicate mixture
Gaviscon
Which PPIs could be given for GORD?
Omeprazole
Lansoprozole
How are PPIs like omeprazole absorbed?
Become active in acidic environment
Absorbed from GIT and delivered to secretory cancel of stomach where activated to sulferamide
What is the mechanism of PPIs?
Modify membrane-inserted proton pumps
Inhibit acid secretion for 10-14 hours
What is important for the timing of PPIs?
At least 40 minutes before meal
PPIs only give full effect after?
Repeated dosing
What are PPIs used for?
Peptic ulcers
GORD
Zollinger-Ellison Syndrome
What is the surgical option for GORD?
Nissen Fundoplication
Tighten valve to prevent oesophagitis
(unlikely to be effective in severe/unresponsive disease)
What is Barrett’s Oesophagus?
Irreversible (unless ablated) metabplastic change from stratified squamous to columnar epithelium as a protective response to persistent reflux of acid/bile
Barrett’s oesophagus moves the _______ more proximal
squamo-columnar junction (Z-line)
What are the risk factors for Barrett’s oesophagus?
GORD Hiatus hernia Obesity Smoking Alcohol
What is the pathological pathway to Barrett’s oesophagus and possible complication?
Norma
Oesophagitis
Barrett’s Oesophagus
Adenocarcinoma
How do you manage Barrett’s?
Lifestyle advice
Radiofrequency ablation
PPIs
Oesophagectomy
What causes acute oesophagi’s?
Chemical ingestion (bleach, caustic substances) or infectious agent (candidiasis, herpes, CMV) in immunocompromised patients)
What type of inflammation occurs with allergic oesophagi’s?
Eosinophilic
What are risk factors for allergic oesophagitis?
Personal or FHx of atopy
Asthma
being young
What are investigations for allergic oesophagitis?
pH probe negative for reflux
Increased eosinophils in blood
Corrugated ‘feline’ or ‘spotty’ oesophagus
How do you treat allergic oesophagitis?
Steroids
Cromoglycate +/- Montelukast
