Oesophagus

Question 1

Hiatus Hernia

Answer 1

Asymptomatic, Oesaphageal hiatus is in right crus of diaphragm at T10. Causes stomach to enter thorax.
2 types: Sliding- GOJ slides through hiatus, lies above diaphragm. Lower sphincter becomes less competent, causing acid reflux.

Rolling- Fundus goes up alongside GOJ. Sphincter remains below diaphragm. Presents with significant pain and may require surgery for gastric volvulus and strangulation.

Question 2

Risk factors for GORD

Answer 2

Anatomical: Diaphragm malformation, Hiatus Hernia, Obesity, Pregnancy, Trauma, Sphincter dysfunction, loss of oesophageal peristaltic function, surgery in achalasia.

Physiological: Spicy food, Zollinger-Ellison syndrome, H. Pylori, NSAIDs, Smoking alcohol, Gastric Acid hypersecretion, Slow gastric emptying and pregnancy.

Question 3

3 cardinal symptoms of GORD:

Answer 3

1) Retrosternal burning, chronic pain in upper abdomen due to dyspepsia. Can be divided into reflux type (Heartburn and regurgitation), Ulcer Type (epigastric pain), Dysmotility type (Bloating and nausea).
2) Waterbrash/Acid regurgitation: GORD symptoms only occur if prolonged contact of gastric contents with oesophageal mucosa. Leads to oesophagitis, stricture and Barrett’s. Regurgitation is worse on bending/lying.
3) Dysphagia including night cough.

Treat empirically with PPI- red flag symptoms indicate endoscopy.

Question 4

Investigations to confirm GORD diagnosis

Answer 4

Endoscopy identifies malignant causes: malignancy, hiatus hernia, oesophagitis, and Barrett’s Oesophagus.
Younger patients are on pharma therapy and kept unless ALARMS 55 symptoms. If no diagnosis via endoscopy, 24-hour pH monitoring.