GORD, hiatus hernia Flashcards
GORD sx
2 or more heartburn episodes /wk
Complications of GORD
Oesophagitis
Ulcers
Benign stricture
Barrett’s oesophagus
Changes in Barretts
oesophageal epithelium metaplasia from squamous to columnar
Criteria for GORD endoscopy
symptoms for >4wks
persistent vomiting
GI bleeding/iron deficiency
palpable mass
age >55
dysphagia;
resistant/relapsing symptoms
wt loss
Ix of GORD
Endoscopy
Barrium swallow (hiatus hernia)
24hr oesophageal pH monitoring +/- manometry (if endoscopy normal)
GORD rx
Antacids, eg magnesium trisilicate mixture
Alginates, eg Gaviscon Advance® (10–20mL/8h PO)
PPI, eg lansoprazole
H2 blockers Ranitidine
Surgery for GORD
Nissen fundoplication
HALO® or Stretta radiofrequency ablation of the gastro- oesophageal junction
Los Angeles classification of GORD
- ≥1 mucosal break(s) <5mm long not extending beyond 2 mucosal fold tops.
- Mucosal break >5mm long limited to the space between 2 mucosal fold tops.
- Mucosal break continuous between the tops of 2 or more mucosal folds but which involves less than 75% of the oesophageal circumference.
- Mucosal break involving ≥75% of the oesophageal circumference.
Mucosal break: a well-demarcated area of slough/erythema
2 types of hiatus hernia
sliding hiatus hernia 80%
rolling hiatus hernia 20%
Sliding hiatus hernia
gastro-oesophageal junction slides into the chest
Rolling hiatus hernia
gastro-oesophageal junction remains in the abdomen
but a bulge of stomach herniates up into the chest
Sliding hiatus hernia reflux
Acid reflux often happens as the lower oesophageal sphincter becomes less competent
Rolling hiatus hernia reflux
As the gastro-oesophageal junction remains intact, gross acid reflux is uncommon.
Dx of hiatus hernia
Barrium swallow
Rx of hiatus hernia
Lose wt
Rx reflux
Surgery if:
- rolling (could strangulate)
- sliding if sx persists despite medical rx
