MET 3 - GORD

Question 1

Enzo is complaining of heartburns. The endoscopy shows no oesophagitis.

Explain the difference between the two?

2 marks

Answer 1

Oesophagitis is inflammation of the oesophageal mucosa. It is caused by chronic reflux of stomach contents causing damage to the oesophageal mucosa [1].

Heartburn is a pain sensation relayed to the brain when there is acid reflux into the oesophagus. [1]

Reflux can cause heartburns without the musoca been chronically inflamed.

Question 2

Name a complication of chronic chronic oesophagitis and (ii) describe the histological presentation.

2 marks

Answer 2

(i) Barrett’s oesophagus.

(ii) Abnormal change (metaplasia) in the cells of the lower portion of the oesophagus

Question 3

What is the mechanism of action of Alginates in treating GORD (1 mark)

Answer 3

They form a ‘raft‘ that floats on the surface of stomach contents. This reduces reflux and protects the oesophageal mucosa.

Question 4

What is the main digestive problem Enzo will have if he abuses the use of Gaviscon and the antacid it contains? Explain your answer

2 marks

Answer 4

1 mark for each (max 2 marks)

• Overall it will lead to impaired protein digestion
• Reduced activation of pepsinogen (HCl is necessary to make pepsin from inactive zymogen)
• Raised pH will reduce pepsin activity (each enzyme has an optimal pH to work)
• lower pH might also impair the inactivation of ingested microorganisms such as bacteria

Question 5

Name three anatomical features which prevent reflux

3 marks

Answer 5

(1 mark for each of these up to a max of 3)

 A viable lower oesophageal sphincter which normally seals off the stomach from the oesophagus.
 The angle at which the oesophagus enters the stomach.
 The presence of the terminal portion of the oesophagus inside the abdominal cavity.
 Contraction of the crural diaphragm exerts a ‘pinchcock‘ action at the terminal oesophagus.