GORD and Dysmotility

Question 1

What are some of the main causes of GORD?

Answer 1

Incompetent LOS
Poor oesophageal clearance
Barrier function/visceral sensitivity

Question 2

What are some of the symptoms of GORD?

Answer 2

Heartburn - aggregated by lying down after a meal (promotes acid exposure)
Acid Refluc 
Water brash (excessive salivation)
Dysphagia 
Odynophagia

Weight loss
Coughing - nocturnal cough/asthma

Question 3

What is Odynophagia?

Answer 3

Pain when swallowing

Question 4

What investigations would you do in GORD?

Answer 4

Endoscopy - to see if Barrett’s or GORD, if GORD need to have symptoms for > 4 weeks

Ba swallow

Oesophageal manometry & pH studies

Nuclear studies

Question 5

What is Dyspepsia?

Answer 5

Dyspepsia, also known as indigestion or upset stomach, is a term that describes discomfort or pain in the upper abdomen. It is not a disease. Dyspepsia is a group of symptoms which often include bloating, nausea and burping.

Question 6

What is dysphasia?

Answer 6

Difficulty swallowing

Question 7

What is the 5 year survival rate of oesophageal adenocarcinoma?

Answer 7

5-10% 5 year survival rate

Question 8

Is Barrett’s or oesophagitis reversible?

Answer 8

Oesophagitis - yes

Barrett’s - Not really

Question 9

What is the basic management of GORD?

Answer 9

Symtom relief
Healing Oesophagitis
Prevent complications

Question 10

What lifestyle modifications would you recommend to someone with GORD?

Answer 10

Stop smoking
Lose weight if obese
Prob up the bed
Avoid provoking factors

Question 11

What are antacids and name examples?

Answer 11

Symptomatic relief
No healing or prevention benefit
E.g Gaviscon

Question 12

Describe H2 antagonists, mechanism?

Answer 12

Competitive antagonists of histamine at the parietal cells H2 receptor. Reduced gastric acid production (less effective than PPI)

Question 13

Describe some examples of H2 antagonists?

Answer 13

Ranitidine

Cimetidine

Question 14

Describe the mechanism of PPIs?

Answer 14

Irreversibly blocking the H+/K+ ATPase of the gastric parietal cells. Inhibiting acid secretion. PPIs are pro-drugs activated only in the acidic environment

Question 15

Describe some examples of PPIs?

Answer 15

Omeprazole

Lansoprazole

Question 16

Are PPIs or H2 antagonists better at symptomatic relief and healing effect?

Answer 16

PPIs are better

Question 17

Describe surgery (endoscopic fundoplication) in GORD?

Answer 17

Controls the symptoms in most patients
Heals the oesophagitis
Young patients more common
Only in severe/unresponsive disease

Question 18

What 2 types of hiatus hernia can you get?

Answer 18

Sliding hiatus hernia

Parasoohgeal hiatus hernia

Question 19

What is gastroparesis?

Answer 19

Delayed gastric emptying

No physical obstruction

Question 20

What are the symptoms of gastroparesis?

Answer 20

Feeling of fullness

Nausea

Vomiting

Weight loss

Upper abdominal pain

Question 21

What can be some causes of gastroparesis?

Answer 21

Idiopathic 
Diabetes mellitus 
Cannabis 
Medication - opiates 
Systemic diseases - systemic sclerosis

Question 22

What is Achalasia?

Answer 22

Achalasia is a serious condition that affects your esophagus. The lower esophageal sphincter (LES) is a valve that closes off the esophagus from the stomach. If you have achalasia, your LES fails to open up during swallowing, which it’s supposed to do. This leads to a backup of food within your oesophagus.