GORD - Gastroesophageal reflux disease

Question 1

What is GORD?

Answer 1

gastric reflux caused by Lower oesophageal sphincter (LOS) dysfunction
Leading to symptoms of OESOPHAGITIS

Question 2

Pathophysiology of GORD
and associated rf

Answer 2

Raised intragastric pressure (obesity and pregnancy)

Reduced sphincter tone (drugs induced- nitrates, CCB)

Anatomical abnormalities of the GOJ (hiatus hernia)

Oesophageal dysmotility
smoking
alcoholism

Question 3

Oesophageal presentation of GORD

Answer 3

Heartburn/retrosternal pain: related to meals, worse when lying down, relieved by antacids
Dysphagia
Chronic cough

Question 4

Extra oesophageal symptoms of GORD

Answer 4

Nocturnal asthma
Chronic cough
Laryngitis, Sinusitis

Question 5

GORD Red Flags

Answer 5

Red flags

> 55 years
Weight loss
Treatment resistant
Dysphagia
DYSPEPSIA
Anaemia

= ENDOSCOPY (Refer for Upper GI endoscopy within 2 weeks)

Gastroscopy for exclude malignancy of the upper GI tract and complications of GORD (i.e. stricture, Barrett’s).

Question 6

DX GORD

Answer 6

1st - two-week PPI trial
2nd - OGD - reserved for red flags tho

Exclude DDX - Testing for Helicobacter pylori

Question 7

TX GORD

Answer 7

Lifestyle change (wtloss, avoid trigger food/meds, smaller meals, stop smoking and alcohol)

Pharmacological: PPIs e.g. lansoprazole/omreprazole

Surgical: laparoscopic/Nissen fundoplication (tying fungus around the LO to narrow the LOS)

Question 8

Complications of GORD

Answer 8

osephageal cancer / Barret osephagus

Question 9

Barrett’s Oesophagus

Answer 9

Metaplasia of the lower oesophageal mucosa (STRATIFIED SQUAMOUS to COLUMNAR epithelium with goblet cells)

Pre-malignant: MASSIVE RF for adenocarcinoma of the oesophagus

7M>F

Question 10

Classic patient Px of Barrett’s oesophagus

Answer 10

Middle aged Caucasian male with long history GORD and dysphasia

Question 11

Investigations Barrett’s oesophagus

Answer 11

Endoscopy + Biopsy
GASTROSCOPY

Question 12

Management of Barrett’s oesophagus

Answer 12

Lifestyle advise: weight loss, reduce caffeine, avoid smoking

Acid neutralising medication: Gaviscon

Proton pump inhibitors: OmePRAZOLE, LansoPRAZOLE

Endoscopic surveillance with biopsies

Question 13

Risk factors for progression to adenocarcinoma in Barrett’s oesophagus

Answer 13

Male
Older age
>8cm segment
Intestinal metaplasia
GORD duration
Alcohol, smoking, obesity
Achalasia (loss of peristalsis )