Oesophagus and GORD

Question 1

What protective mechanisms make of up anti-reflux barrier?

Answer 1

• Intrinsic sphincter
• Extrinsic sphincter
• Intra-abdominal oesophagus
• Angle of His/flap valve (failure can give acid reservoir)
• Secondary peristalsis of oesophagus and swallowed bicarbonate (impaired acid clearance)

Question 2

What is the difference in the mucosal structure between stomach and oesophagus?

Answer 2

Stomach = simple columnar 
Oesophagus = stratified squamous non-K`

Question 3

Why does gastric acid damage oesophagus?

Answer 3

Gastric mucosa secretes a think layer of alkaline mucus to protect it from damage, but oesophageal mucus isn’t adapted for this function

Question 4

What causes GORD?

Answer 4

Failure of any protective mechanisms, or increasing offences e.g. more reflux.

Question 5

What can frequent acid reflux due to LOS incompetency cause?

Answer 5

Oesophagitis, oesophageal ulceration, heartburn

Question 6

How does columnar and intestinal metaplasia of the oesophagus occur?

Answer 6

Recurrent damage can results in squamous mucosal change to resemble that of the stomach/SI

Question 7

What can extensive intestinal metaplasia of the distal oesophagus lead to?

Answer 7

Barrett’s; can progress to adenocarcinoma

Question 8

What is hiatus hernia?

Answer 8

Protrusion of part of the stomach through the diaphragmatic hiatus into the chest.
Sliding = gastro-oesophageal junction (80%)
Rolling = fundus

Question 9

What offences can lead to GORD?

Answer 9

Increased intra-abdominal pressure (e.g. in obesity)

Reduced gastric emptying

Question 10

What is the definition of GORD?

Answer 10

Symptoms and complications of retrograde passage of acidic gastric contents into the oesophagus.

Question 11

What are GORD risk factors and symptoms?

Answer 11

Obesity
Acid regurgitation and heartburn 
Dyspepsia 
Age
Hiatus hernia
LOS tone reducing drugs
NSAIDs

Question 12

What are the red flag symptoms in GORD?

Answer 12

Dysphagia: caused by structural cause (intrinsic lesion e.g. mass, extrinsic lesion e.g. lymph nodes) or functional cause e.g. achalasia, neuromuscular disease e.g. bulbar palsy

Unexplained weight loss
Persistent vomiting
Evidence of GI blood loss
Upper abdominal mass

Question 13

What are the complications of GORD?

Answer 13

1. Oesophagitis (strictures)
2. Barrett’s
3. Adenocarcinoma

Question 14

Who is most at risk of GORD?

Answer 14

White men
> 50
Smokers
Previous hiatus hernia

Question 15

How is endoscopy performed?

Answer 15

Topical anaesthesia/conscious sedation
Help to diagnose hiatus hernia, tumours, Barrett’s
Biopsy can be taken
Structural problems only, normal endoscopy means functional cause

Question 16

What is high-resolution manometry?

Answer 16

Catheter through nose, record pressure at sphincters

Motility disorders

Question 17

How is GORD treated?

Answer 17

Lifestyle
Meds
Surgery

Question 18

What is Nissen fundoplication?

Answer 18

Laparoscopic anti-reflux surgery, improves valve mechanism at LOS.
Fundus is wrapped around lower oesophagus

Question 19

What is atrophic gastritis?

Answer 19

Chronic inflammation of the fundic glands, leading to parietal cell atrophy and reduced gastric acid secretion.

Parietal cell destruction leads to hypochlorhydria and increased gastrin levels and G cell hyperplasia

ECL cells also increase due to gastrin