GORD, Functional dyspepsia

Question 1

What does GORD stand for?

Answer 1

Gastro-oesophageal reflux disease

Question 2

What is the worldwide prevalence of GORD?

Answer 2

5-10% of Westernised adults have symptomatic GORD

Question 3

What is the function of the lower oesophageal sphincter, what happens to it in GORD?

Answer 3

The lower oesophageal sphincter consists of rings of muscle fibres which prevent the backflow of stomach and sometimes duodenal contents back into the oesophagus, hence protecting the oesophagus from acidic juices. When these smooth muscle fibres do not contract fully this can lead to the backflow of stomach contents resulting in GORD.

Question 4

What are the causes of presence of gastric juices within the oesophagus?

Answer 4

Usually due to a defective lower oesophageal sphincter normally caused by lowered pressure of the sphincter causing relaxation.

Factors that lower the pressure of the LOS:
Diet - high chocolate, alcohol, caffeine, fat
Having large fatty meals
Cigarette smoking
Drugs
Endocrine - oral contraceptives, HRT, pregnancy

Question 5

What percentage of pregnant mothers suffer with GORD?

Answer 5

50%

Question 6

Is GORD categorised by any reflux?

Answer 6

No, only when reflux occurs frequently and is severe (after most meals) and/or has resulted in mucosal damage

Question 7

Does the severity of symptoms correlate to extent of inflammation caused by GORD?

Answer 7

No, very severe symptoms does not always correlate to extensive inflammation (oesophagitis) and vice versa

Question 8

Describe how a hiatus hernia occurs.

Answer 8

A hiatus hernia is when the upper part of the stomach is pushed up into the chest cavity through the diaphragm (the large muscle that separates the abdomen and the chest). This usually occurs when there is a weakness in this muscle.

Question 9

How can a hiatus hernia cause GORD?

Answer 9

Presence of a hiatus hernia can alter the position of the lower oesophageal sphincter which prevents the smooth muscle fibres causing complete closure, increasing backflow potential.

Question 10

What percentage of the population may have a hiatus hernia?

Answer 10

30-50%

Most are asymptomatic but some can present as GORD/heartburn

Question 11

What are some drugs that are known to reduce the LOS pressure (potentially cause GORD)?

Answer 11

Anticholinergics
Beta-2 agonists
Calcium channel blockers
Diazepam
Nitrates
Alcohol
Progesterones
Oral contraceptives
Theophylline

Question 12

What are some drugs that are known to cause oesophageal ulceration?

Answer 12

NSAIDS
Bisphosphonates
Clindamycin
Clotrimoxazole
Doxycycline
Potassium
Theophylline
Tetracycline

Question 13

How can the potential for oesophageal ulceration be reduced?

Answer 13

Taking with a fully glass of water
Standing/sitting upright whilst taking and for 30 minutes afterwards
Taking on an empty stomach
Ensuring patients read the information leaflet
Reporting of GI associated side effects to GP/Pharmacist

Question 14

Which type of drugs are responsible for 50% of drug induced oesophagitis?

Answer 14

Antibiotics especially Clindamycin in the capsule form

Question 15

What are some of the gastro-associated effects with GORD?

Answer 15

Motility of the oesophagus may be abnormal due to inflammation
Gastric emptying is delayed in 40% of patients (contents remain longer in the stomach, refluxing)

Question 16

What are the main symptoms of GORD?

Answer 16

Heartburn
Acid reflux (unpleasant taste in the mouth)
Hoarseness
Chronic cough
Dysphagia
Odynophagia (pain on swallowing)

Bloating
Belching
Bad breath
Nausea and/or vomiting

Question 17

What are the main complications of GORD?

Answer 17

Barret’s oesophagus - changes in the cells lining the oesophagus, oesophageal cancer can rise from these cells
Haemorrhage
Strictures

Question 18

How is GORD diagnosed?

Answer 18

Only by endoscopy

Question 19

What is functional dyspepsia also known as?

Answer 19

Non-ulcer dyspepsia

Question 20

What is functional dyspepsia?

Answer 20

Functional dyspepsia is the name given to diagnosed patients that have presented with dyspeptic symptoms relating to the gastro-duodenal region but upon investigation no evidence of organic, systemic or metabolic disease.
Believed to may relate to gastric hypersensitivity

Question 21

What percentage of patients with chronic dyspepsia have functional dyspepsia?

Answer 21

Around 50%

Question 22

What are the four classifications of functional dyspepsia?

Answer 22

Symptoms that are:

Ulcer like
Dysmotility like
Reflux like
Non-specific

Not always distinct

e.g patient presents with ongoing heartburn, but endoscopic findings do not suggest there is any evidence of organic disease therefore diagnosed with functional dyspepsia

Question 23

What are the main complications of functional dyspepsia?

Answer 23

No increased risk of gastric or oesophageal cancer but symptoms are chronic and therefore lead to a reduced quality of life for the patient.

Question 24

What is the management plans for functional dyspepsia?

Answer 24

Eradicate H pylori if present
Check if anxiety induced
Neutralise acid production or reduce production for symptomatic relief
Periodic monitoring (safety netting)

Question 25

What is the most likely diagnosis of heartburn, pain with or immediately after food?

Answer 25

Undergo endoscopy:
No organic disease - functional dyspepsia
Organic disease - GORD

Question 26

What is the most likely diagnosis of epigastric pain, pain with or immediately after food?

Answer 26

Undergo endoscopy:
No organic disease - functional dyspepsia
Organic disease - Gastritis, Gastric ulcer

Question 27

What is the most likely diagnosis of epigastric pain, pain in between meals or at night or pain relieved by eating?

Answer 27

Undergo endoscopy:
No organic disease - functional dyspepsia
Organic disease - Gastritis, Duodenal ulcer