The Oesophagus - GORD

Question 1

What is GORD?

Answer 1

Gastro-Oesophageal Reflux Disease - acid from the stomach refluxes through the LOS and irritates the lining of the oesophagus.

Question 2

Histological Adaptations of the Oesophagus and Stomach.

Answer 2

Stomach : Columnar Epithelial Lining (protected against acid).
Oesophagus : Squamous Epithelial Lining (sensitive to acid).

Question 3

What is Dyspepsia? (6)

Answer 3

A non-specific term used to describe indigestion including :-

1. Heartburn.
2. Acid Regurgitation.
3. Retrosternal/Epigastric Pain.
4. Bloating.
5. Nocturnal Cough.
6. Hoarse Voice.

Question 4

Clinical Features of GORD (4).

Answer 4

1. Dyspepsia.
2. Bloating, Belching.
3. Laryngitis, Globus.
4. Tooth Erosion & Waterbrash.

Question 5

Risk Factors of GORD (4).

Answer 5

1. Increased Intra-Abdominal Pressure (Obesity and Pregnancy).
2. Reduced LOS Tone (Smoking, Alcohol, Coffee).
3. Hiatus Hernia.
4. Intake of Specific Foods e.g. Citrus, Spicy, Fat.

Question 6

Investigations of GORD (3).

Answer 6

1. Upper GI Endoscopy.
2. 24 Hour Oesophageal pH Monitoring (Gold-Standard).
3. Clinical Diagnosis + Therapeutic PPI Trial.

Question 7

Referral Criteria for Upper GI Endoscopy - 2 Week Wait (2F).

Answer 7

1. Dysphagia (any age).
2. ABOVE 55.
   2A. Weight Loss.
   2B. Upper Abdominal Pain/Reflux.
   2C. Treatment Resistant Dyspepsia (>4 weeks).
   2D. Nausea and Vomiting.
   2E. Low Haemoglobin.
   2F. Raised Platelet Count.

Question 8

Indications for Endoscopy (4).

Answer 8

1. GI Bleed.
2. Peptic Ulcers.
3. Oesophageal Malignancy.
4. Gastric Malignancy.

Question 9

Management of GORD (4).

Answer 9

1. Lifestyle Advice.
2. Acid-Neutralising Medications when Required.
3. PPIs to reduce acid secretion (or alternative).
4. Surgery.

Question 10

What lifestyle advice can be given for GORD? (4)

Answer 10

1. Reduce tea, coffee and alcohol intake.
2. Weight loss.
3. Smoking Cessation.
4. Smaller & Lighter Meals - avoiding Heavy Meals before bedtime and staying upright after meals.

Question 11

Acid-Neutralising Medications in GORD (2).

Answer 11

1. Gaviscon.

2. Rennie.

Question 12

Examples of PPIs (2).

Answer 12

1. Omeprazole.

2. Lansoprazole.

Question 13

Mechanism of Action of Antacids & Alginates (3).

Answer 13

1. Antacids : Buffer stomach acids.
2. Alginates : Increase viscosity of stomach contents to reduce reflux.
3. Together, after reacting with acid, they form a floating raft to separate gastric contents from the GOJ.

Question 14

What alternative medication can be given instead of PPIs?

Answer 14

Ranitidine - H2 Receptor Antagonist (Antihistamine).

Question 15

What surgery is available for GORD?

Answer 15

Laparoscopic fundoplication - tying the funds of the stomach around the lower oesophagus to narrow the LOS.

Question 16

Management of Endoscopically-Proven GORD (3).

Answer 16

1. Full-Dose PPI for 1-2 months.
2. If responsive, continue low-dose treatment as required.
3. If unresponsive, double-dose PPI for 1 month.

Question 17

Management of Endoscopically-Negative GORD (3).

Answer 17

1. Full-Dose PPI for 1 month.
2. If responsive, offer low-dose treatment PRN with limited repeat prescriptions.
3. If unresponsive, H2 Receptor Antagonist or Prokinetic for 1 month.

Question 18

Complications of GORD (6).

Answer 18

1. Oesophagitis.
2. Ulcers.
3. Anaemia.
4. Benign Strictures.
5. Barrett’s Oesophagus.
6. Oesophageal Carcinoma.