General: GORD

Question 1

Discuss the pathophysiology of GORD

Answer 1

Gastric acid from the stomach leaks up into the oesophagus

Lower oesophageal sphincter controls passage of contents from oesophagus to stomach = episodes of sphincter relaxation are more frequent = reflux

= mucosal damage

Question 2

What are the risk factors for GORD

Answer 2

Age

Obesity

Alcohol

Smoking

Caffeinated drinks

Fatty or spicy foods

Question 3

How does GORD present?

Answer 3

Chest pain = burning retrosternal sensation, worse after meals, lying down, bending over, or straining

Excessive belching

Odynophagia = pain on swallowing food/liquid

Chronic cough or nocturnal cough

Hoarseness

Red flag = dysphagia, weight loss, early satiety, malaise and loss of appetite

Question 4

What investigations should be performed when GORD is suspected?

Answer 4

Clinical diagnosis

Endoscopy = malignancy and investigate for complications of reflux (Barrett’s)

24hr pH monitoring = gold standard

Oesophageal manometry (measures strength and muscle coordination) = exclude oesophageal dysmotility

Question 5

How is GORD best managed?

Answer 5

Avoiding known precipitants = alcohol, coffee, fatty foods

Weight loss

Smoking cessation

Raising the head of the bed

Having evening meals at least 3 hours before bed

PPI

Fundoplication = gastro-oesophageal junction and hiatus are dissected, fundus wrapped around the GOJ, recreating physiological lower oesophageal sphincter

Stretta = radio-frequency energy delivered endoscopically to cause thickening of the LOS

Linx = string of magnetic beads is inserted around the LOS laparoscopically which tightens the LOS

Question 6

Name the possible complications from GORD

Answer 6

Aspiration pneumonia

Barrett’s oesophagus

Oesophagitis

Oesophageal stricture

Oesophageal cancer