Gastro-oesophageal reflux disease Flashcards
Tell me about Gastro-oesophageal reflux disease (GORD)
It is common and affects 30% of the general population
It is diagnosed when there is reflex of gastric contents causing symptoms that happen twice or more per week
What complications may occur with prolonged GORD
Oesophagitis
Barret’s oesophagus (premalignant)
Benign oesophageal stricture
Iron deficiency anaemia - because of bleeding from oesophagitis (Ulcers). Rule out colorectal cancer and hiatus hernia.
What can cause Gastro-oesophageal reflux disease
Hiatus hernia
Gastric acid hypersecretion
slow gastric emptying
Obesity/pregnancy
overeating
smoking
alcohol
Systemic sclerosis
What medications can cause gastroesophageal reflux disease
tri-cyclic anti-depressants, anticholinergics, nitrates
Symptoms of gastroesophageal reflux disease
retrosternal burning pain/discomfort after meals, stooping, straining, lying.
Releived by antacids
Belching (t3’ar)
increased salivation (water brash)
Odynophagia may develop with oesophagitis or ulcer formation
What are the extra-oesophageal manifestations of gastroesophageal reflux disease
Nocturnal asthma
Chronic cough
Laryngitis (hoarsness, clear throat)
Sinusitis - inflamed linings of sinuses
What histological changes occur in barret’s oesophagus
Distal oesophageal epithelium undergoes metaplasia from squamos to columnar which makes it look velvety.
When does benign oesophageal stricture develops
It develops as a result of long term oesophagitis
It is commonest in elderly complaining of dysphagia especially when eating solids
Diagnose with endoscopy and take biopsy to exclude malignancy. Maybe put balloon
Long term PPI treatment to prevent recurrence
What investigations to carry for gastroesophageal reflux disease
Endoscopy
Barium swallow for suspected hiatus hernia
24-Hr PH monitoring if Dx unclear after endoscopy or when surgery is indicated.
When to investigate with endoscopy in gastroesophageal reflux disease
If Px less than 55 treat unless they have ALARM symptoms
If Px older than 55 perform endoscopy
Medical treatment of gastroesophageal reflux disease
Antacids for symptomatic control but not treatment
PPI are good for treating but some patients require long term. PPI better than H2 antagosints, if not sufficient try PPI twice daily.
Metoclopromide is not recommended
What advice you would want to give for patients with gastroesophageal reflux disease
Conservative treatment;
Smoking cessation, avoid alcohol, small frequent meals.
Avoid hot drinks, spicy food, and dietary triggers.
Weight loss
Raise head at night
How is gastroesophageal reflux disease graded
Los Angeles classification of GORD
