GORDS

Question 1

What are the main causes of GORD?

Answer 1

Incompetent lower oesophageal sphincter (LOS)
Poor oesophageal clearance
Defects in barrier function/visceral sensitivity

Question 2

What is GORD?

Answer 2

Characterised by retrosternal and sometimes epigastric pain due to the reflux of acidic stomach contents into the oesophagus.

Question 3

Name some risk factors for GORD

Answer 3

Hiatus hernia
Certain foods (e.g., fat, caffeine) Smoking
Obesity, alcohol
H. pylori infection
Stress

Question 4

How does an incompetent lower oesophageal sphincter contribute to GORD?

Answer 4

LOS relaxes inappropriately or fails to contract adequately, allowing stomach acid to reflux into the oesophagus, especially during times when it should remain contracted

Question 5

What are some clinical symptoms of GORD?

Answer 5

Dyspepsia
Waterbrash
Haematemesis
Odynophagia
Dysphagia
Chest pain
Coughing

Question 6

What are some signs of GORD?

Answer 6

Weight loss, hoarseness, and dental erosion

Question 7

What further investigations are recommended for GORD patients whose symptoms do not respond to standard treatment?

Answer 7

H. pylori testing
Endoscopy
24-hour luminal pH
Manometry
Barium swallow

Question 8

What is the role of endoscopy in GORD diagnosis? - MAIN

Answer 8

Endoscopy assesses inflammation levels, allows for biopsy, and can dilate strictures if present

Question 9

How is H. pylori infection tested in GORD patients?

Answer 9

H. pylori testing is done through breath test or stool antigen test

Question 10

What medications are commonly used in GORD management?

Answer 10

Antacids, PPIs (Proton Pump Inhibitors), and H2 receptor antagonists

Question 11

When are PPIs prescribed in GORD management?

Answer 11

PPIs are prescribed if symptoms persist despite lifestyle changes and antacid use

Question 12

What is the purpose of H2 receptor antagonists in GORD management?

Answer 12

H2 receptor antagonists are prescribed if symptoms persist despite PPIs or are taken alongside PPIs

Question 13

What complications can arise from untreated GORD?

Answer 13

1. Barrett’s oesophagus metaplasia of lower oesophageal epithelium > which increases the risk of adenocarcinoma

Question 14

Explain what Barium swallow shows

Answer 14

Hiatus hernia or strictures if present

Question 15

A 56-year-old is attending his GP with retrosternal discomfort after meals and a chronic cough. The GP suspects gastro-oesophageal reflux disease and wishes to investigate for a hiatus hernia. Which is the best diagnostic test?

Answer 15

Barium swallow

Question 16

A 42 year old man presents to his GP complaining of heartburn exacerbated by eating and lying flat. He reports that it is improved with antacids. He denies any haematemesis, weight loss, anorexia or dysphagia. Examination is unremarkable. He has no significant past medical history. What is the most appropriate management of this patient?

Answer 16

Offer a carbon-13 urea breath test

Question 17

A 24-year-old woman presents to her GP at 30 weeks gestation suffering from ‘heartburn’. She describes a retrosternal burning sensation, which commonly occurs following eating, or when lying in bed at night.

Which hormone is responsible for the promotion of smooth muscle relaxation, which contributes to reduced oesophageal tone and reflux oesophagitis?

Answer 17

Progesterone

Question 18

A 45-year-old nurse presents to the emergency department with a 12-hour history of profuse watery diarrhoea and vomiting. There is no blood in the stool. She has no abdominal pain and is able to tolerate oral fluids. Some of the patients on the ward she has been working on have also come down with diarrhoea and vomiting. Cause of this presentation?

Answer 18

Norovirus

Question 19

A 56-year-old man is attends his GP with retrosternal discomfort after meals, regurgitation when lying flat and a chronic cough. He is referred for a barium swallow, which demonstrates a sliding hiatal hernia. His GP wishes to start the patient on antihypertensive medication. Given the patient’s past medical history, which medications should be avoided?

Answer 19

Calcium channel blockers = relax the sphlinter

Question 20

A 51-year-old gentleman with a body mass index (BMI) of 36 and a past medical history of gastro-oesophageal reflux disease (GORD) undergoes an endoscopy for investigation of treatment-resistant dyspepsia. A biopsy is taken, which confirms a diagnosis of Barrett’s oesophagus.

What is most likely seen on the histological examination of biopsies of those with Barrett’s oesophagus?

Answer 20

Metaplasia

= replacement of normal stratified squamous epithelium by simple columnar epithelium

Question 21

A 26-year-old woman presents with diarrhoea and weight loss. An endoscopy is performed which reveals a flattened duodenal mucosa with scalloping of the folds. What is the most likely diagnosis?

Answer 21

Coeliac disease

Question 22

You are bleeped to see a 33 year old man who has been on the gastroenterology ward for acute severe ulcerative colitis. He has been receiving treatment with intravenous hydrocortisone. However, over the last three hours, he has developed distension and worsening pain in the abdomen. His observations show: RR 20/min, oxygen saturations 98%, HR 124bpm, BP 100/60mmHg, temperature 38.8C. What would be the next appropriate step?

Answer 22

Abdominal x-ray

Question 23

A 34-year-old man registers at a new GP surgery. He was diagnosed with coeliac disease two years ago and has been managing the condition with a strict gluten-free diet. He is now concerned about complications of the disease and asks his GP for advice on which tests he needs. Which investigations could be carried out to monitor for complications in a patient with coeliac disease?

Answer 23

DEXA scan

Question 24

A 27-year-old man presents to his GP with chronic diarrhoea. He takes no regular medications and has no past medical history. Which would be more suggestive of inflammatory bowel disease compared with irritable bowel syndrome?

Answer 24

Passing blood with stool

Question 25

A 65-year-old lady, with a past medical history of osteoarthritis and on long-term naproxen use for pain control, presents to the A&E with dizziness. On questioning, she reports having passed a black tarry stool for the previous 3 days. On examination, she is haemodynamically stable, with cool, pale peripheries and mild pallor. Blood tests reveal: Hb 82 g/L (normal range 115-150 g/L) and and MCV or 79 fL (normal rnage 80-96). A provisional diagnosis of an upper gastrointestinal bleed is made. Which biochrmistry findings most likly to confirm diagnosis

Answer 25

High urea