Gastro-Oesophageal Reflux Disease Flashcards
(35 cards)
What is the oesophageal hiatus?
Oval apeture in right crus of diaphragm at T10
What structures pass through the oesophageal hiatus?
Oesophagus
Vagal nerve trunks
Oesophageal branches of L. gastric vessels/lymphatics
What is a hiatus herniae?
Protrusion of the stomach through oesophageal opening of the diaphragm
How do hiatus herniae typically present?
Asymptomatic
Occasionally reflux causing pain
What are the two anatomical types of hiatus herniae?
Sliding hiatus herniae
Para-oesophageal herniae (rolling)
Describe the anatomical change in a sliding hiatus herniae
Entire stomach slides up through opening next to oesophagus
Describe the anatomical change in a para-oesophageal hiatus herniae
Outpouching of the stomach rolls up
High risk of strangulation
What are the anatomical risk factors for gastro-oesophageal disease?
Hiatus hernia
What are the physiological risk factors for gastro-oesophageal disease?
Obesity High fatty food intake Pregnancy Alcohol and caffeine intake Smoking Connective tissue disorders e.g. scleroderma Delayed gastric emptying (diabetes)
How do sliding hiatus herniae present?
30% of adults >50
Typically insignificant
Sx may occur due to associated reflux
How do para-oesophageal herniae present?
Severe pain
Gastric volvulus/strangulus (requires surgical intervention)
What is Dyspepsia?
Chronic upper abdominal pain/discomfort
What are the subtypes of dyspepsia?
Reflux (heartburn/regurgitation eg. GORD)
Ulcer (epigastric pain)
Dysmotility (bloating/nausea)
When do sx of GORD occur?
When there is prolonged contact of gastric contents w/ oesophageal mucosa –> oesophagitis
What are the common features of GORD?
Heartburn
-epigastric or retrosternal pain
Acid regurgitation
Nocturnal cough
Hoarse voice
Bloating
Odynophagia
Waterbrash
What are the features of the dyspepsia present in GORD?
Worse on bending/lying down
Hot liquids/alcohol make it worse
Relieve by antacids
What is waterbrash?
Filling of mouth with excessive saliva and acid
What are the features of the atypical chest pain present in GORD?
Nocturnal cough/wheeze
Due to distal oesophageal muscle spasm
How is GORD diagnosed?
Normally a clinical diagnosis
Unless ALARM 55 sx or symptoms of bleeding
What are the red flag sx indicating a need for endoscopy?
ALARMS 55
- anaemia (Fe deficient)
- loss of wt
- anorexia
- not responding to treatment
- N&V
- melaena/haematemesis
- dysphagia
- > 55yrs
- high platelets
What is the empirical treatment of GORD?
PPI
-unless ALARMS 55 sx
What further investigations may be appropriate in GORD?
Barium swallow (?hiatus herniae) 24hr luminal pH monitoring/manometry
What lifestyle measures are used to manage GORD?
Weight loss Stop smoking Decrease alcohol and caffeine Smaller meals Eat at least 2 hours before bed Stay upright after meals
Gaviscon and rennies prn
What medical options are used to manage GORD?
Antacids +/- alginates
PPIs
H2 receptor antagonists
