GORD

Question 1

describe the treatment of GORD without endoscopy.

Answer 1

review medications for possible cause of dyspepsia

lifestyle advice

high dose PPI for 1 month or ‘test and treat’ for H.pylori
(if no response to one then try the other)

Question 2

describe the management of GORD.

Answer 2

GORD diagnosed without endoscopy should be treated as per dyspepsia guidelines

• high dose PPI for one month or ‘test and treat’ for H.pylori
• review meds and lifestyle advice

endoscopy proven oesophagitis;

• full dose PPI for 1-2 months
• if responds then low dose as required
• if no response then double dose PPI for 1 month

endoscopy negative oesophagi’s

• full dose PPI for 1 month
• if response then offer low dose as required
• if no response then H2 receptor antagonist or prokinetic for 1 month

Question 3

what are complications of GORD?

Answer 3

oesophagitis 
barrett's oesophagus 
oesophageal cancer 
anaemia
ulcers
benign strictures

Question 4

what is barrels oesophagus managed?

Answer 4

endoscopic surveillance with biopsies every 3-5 yrs

high dose PPI

if dysplasia is identified then offer endoscopic intervention

• radio frequency ablation
• endoscopic mucosal resection

Question 5

what is the standard approach for an oesophagectomy?

Answer 5

ivor lewis

others;

• left thorax-abdominal
• transhiatal
• total oesophagectomy with cervical oesophagatsric anastomoses

Question 6

what is the main surgical complication from an oesophagectomy?

Answer 6

anastomotic leakage

if there is an intrathoracic anastomotic leakage, this can cause mediastinitis which has a high mortality

Question 7

what are indications for an upper GI endoscopy in a patient who presented with dyspeptic / reflux symptoms?

Answer 7

> 55yrs 
symptoms > 4 week or persistent despite treatment 
relapsing symptoms 
weight loss 
dysphagia

Question 8

in the investigation of dyspepsia/reflux symptoms, if upper GI endoscopy was negative what would be the next step?

Answer 8

24 hour oesophageal PH monitoring