GORD

Question 1

Difference in history of chest pain between GORD and cardiac causes for the pain?

Answer 1

Pain occurs on lying down to go to sleep

Question 2

Why does pain on lying down distinguish GORD from unstable angina?

Answer 2

It doesn’t

- while this may occur in unstable angina, you would expect patient to report pain on increased exertion as well

Question 3

Why does GTN effectiveness not distinguish between GORD and cardiac cause of chest pain?

Answer 3

GTN can relieve both GORD and angina

- relaxes smooth muscle of oesophagus + coronary arteries

Question 4

Associated lifestyle factors/conditions with GORD?

Answer 4

Obesity
Pregnancy
Alcohol + smoking
Hernias
Medications

Question 5

Presentation of GORD?

Answer 5

Intermittent pain/heartburn which may be related to lifestyle factors such as large meals or alcohol
Post-dose in medication-related GORD

Question 6

When is endoscopy indicated?

Answer 6

Anyone over 55 or who have warning signs:

• weight loss
• GI bleeding
• anaemia

Question 7

Management of GORD?

Answer 7

Modification of lifestyle factors 
- weight loss, smoking/alcohol cessation
Pharmacological treatment
- give PPIs
- adjust medication if causing the GORD

Question 8

Complications of long-term reflux?

Answer 8

Development of Barrett’s –> oesophageal cancer

Formation of strictures