Oesophagitis and Reflux

Question 1

What drugs put you at risk of getting GORD (3)?

Answer 1

Anticholinergics
Tricyclics
Nitrates

Question 2

What are the extra-oesophageal signs of GORD (3)?

Answer 2

Nocturnal Asthma
Chronic cough
Laryngitis, Sinusitis

Question 3

Differentials of GORD symptoms (3)?

Answer 3

Oesophagitis:
 - infection: CMV, candida
 - IBD
 - caustic substances/burns
Peptic ulcer disease
Oesophageal cancer

Question 4

What are the criteria for sending a patient for an OGD with GORD

Answer 4

>55years
Symptoms >4 weeks
Dysphagia
Persistent symptoms despite Rx
Wt. Loss

Question 5

As well as an OGD and FBC, what other investigations can you run for suspected GORD (3)

Answer 5

CXR (hiatus hernia)
Barium swallow (hiatus hernia, dysmotility)
24hr pH testing

Question 6

What is the medical management of GORD? (3 steps)

Answer 6

Over the counter antacids

PPI

Question 7

What do you do in terms of medical management if the single PPI does not work after 1-2 months?

Answer 7

Double the dose of PPI

If still no response, add Ranitidine

Question 8

What is the surgical treatment for GORD?

Answer 8

Nissen fundoplication

Question 9

What are the complications of the surgical treatment of GORD?

Answer 9

Gas-bloat syndrome (inability to burp/vomit)
Dysphagia if too tight

(The surgical treatment is a Nissen Fundoplication)