GORD (Gastro-oesophageal reflux disease) Flashcards
What is GORD?
The reflux of gastric contents into the oesophagus caused by a defective lower oesophageal sphincter
What is the epidemiology of GORD?
≈5% adults have symptoms daily.
Three times more common in males than females
What are the lifestyle factors of GORD?
- Obesity
- Alcohol use
- Smoking
- Intake of specific foods (e.g. coffee, citrus foods, spicy foods, fat)
What are some previous medical risk factors of GORD?
- Hiatus hernia
- Lower oesophageal sphincter hypotension
- Loss of oesophageal peristaltic function
- Gastric acid hypersecretion
- Delayed gastric emptying
- Systemic sclerosis
- Pregnancy (raised intra-abdominal pressure, hormonal smooth muscle relaxation)
- Surgery for achalasia (failure of lower oesophageal sphincter to relax due to degeneration of the myenteric plexus)
- Pyloric stenosis (increased gastric contents volume-projectile vomiting)
Drugs (tri-cyclic anti-depressants, anticholinergics, nitrates, alendronate)
Why is obesity a risk factor?
It raises the intra-abdominal pressure
Why is smoking a risk factor?
It may cause a faulty oesophageal sphincter
Why is eating fatty foods a risk factor?
Raised intra-abdominal sphincter
What is the pathophysiology of GORD?
- Extent of mucosal damage depends on: duration of contact, type of gastric content and resistance of epithelia
- Severe reflux= involves oesophagus and inability to contract and clear contents
- Intermittent pharyngeal reflux= symptoms are experienced during sleep when the upper oesophageal junction relaxes
- Reflux induced asthma= caused by aspiration of gastric contents
What are the symptoms of GORD?
- Dyspepsia- Heartburn-(worse at night→ when lying down, stooping or bending) retrosternal burning
- Sensation of acid regurgitation
- Halitosis
- Belching
- N+V
- Epigastric pain
- Globus sensation- persistent sensation of lump in throat
- Onset relating to meals (pain when drinking alcohol or hot liquids)
- Symptoms relieved by antacids
- Odynophagia- pain on swallowing (oesophagitis or ulceration)
What are the alarming features of GORD?
weight loss, anaemia, dysphagia, haeamatemesis, melaena, persistent vomiting
What are some differential diagnoses of GORD?
- Oesophagitis- (caused by corrosive substances & NSAIDS)
- Infection- CMV, HSV, Candida
- Duodenal ulcers
- Gastric ulcers/ cancers
- Dyspepsia
- Heart burn (crushing, radiating to left arm)
What are some investigations used for GORD?
- Trial of PPI therapy
- Endoscopy- used if lifestyle and PPI didn’t work, aged 55 or over with treatment-resistant dyspepsia get it
- OGD if alarm features
- Oesophageal manometry
- Hiatus hernia barium swallow
What is the management of GORD?
- Encourage: weight loss, smoking cessation, raise head rest when sleeping, small/regular meals
- Avoid: Hot drinks, alcohol, eating before sleep
What is the treatment for GORDS?
- PPI (recommended first line) (Lansoprazole/Omeprazole)- inhibits gastric acid secretion by inhibiting H/K ATPase
- Antacids (Gaviscon/ Magnesium Trisilicate)- neutralises gastric acid
- H2-receptor antagonist (Ranitidine)- inhibits gastric acid secretion
- Prokinetic agents- (Metoclopramide)- aids gastric emptying
- Nissen Fundoplication- performed when medical treatment fails → gastric fundus is wrapped around the lower oesophagus→ reinforcing closure of the oesophageal sphincter
What is the prognosis for GORD?
- Most patients respond well to treatment (maintenance PPI treatment is recommended)
- Patients do higher risk of developing Barrett’s Oesophagus or Oesophageal Adenocarcinoma
