Gastro - Oesophageal Reflux Disease Flashcards
(20 cards)
What is gastro oesophageal reflux disease?
Refers to when acid from stomach refluxes through the lower esophageal sphincter and irritates the lining of the oesophagus
What is the cell type of the Oesophagus and stomach?
Oesophagus - stratified squamous. Stomach - Columnar
What are the presenting features of GORD?
Heart-burn, acid reflux, retrosternal / epigastric pain, nocturnal cough, hoarse voice
When might you refer a patient for Endoscopy urgently within 2 weeks?
Dysphagia, age over 55 years old, weight loss, upper abdominal pain / reflux, meleana/coffee ground vomit
When might you refer a patient for Endoscopy non-urgently?
Haematemesis, treatment resistant dyspepsia, nausea and vomiting, low Hb, raised platelets
If patients with dyspepsia do not meet criteria for Endoscopy, what are treatment options?
Full dose 1 month PPI or “test and treat” for H. Pylori
If a patient has confirmed GORD on Endoscopy, what is the treatment?
1-2 months of PPI, if response then continue on low dose. If no response consider double dose
If a patient has no confirmed GORD on Endoscopy but has dyspepsia symptoms, what is the treatment?
1 month of PPI, if response then consider low dose PRN. If no response, consider prokinetic or H2RA for a month
State the tests which can be formed for initial investigation of H pylori?
13-Urea breath test, or stool antigen test
What is the test of cure following H Pylori therapy? When would you do it?
13-Urea breath test, ONLY if they still have symptoms
Outline the Urea Breath test?
Patient consumes a drink of 13-C urea, after 30mins will exhale into a glass tube
What things may interact with Urea Breath test?
PPIs and Antibacterial drugs, hence must be off PPI for 2 weeks or antibacterial for 4 weeks
What type of bacteria is H.pylori?
Gram negative, aerobic bacteria
Outline the Rapid Urease test (CLO) test?
Performed during endoscopy. Biopsy is mixed with pH indicator and urea. Colour change = positive result
What is the eradication therapy for H.pylori?
Triple therapy: PPI + Amoxicillin + Clarithromycin / Metronidazole
What is the eradication therapy for H.pylori if penicillin allergic?
PPI + Clarithromqycin + Metronidazole
What is a rare side-effect of PPI?
Hypomagnesemia - causing muscle aches
What are triggers/risk factors for GORD?
Greasy, spicy food
Smoking
Alcohol
Obesity
Caffeinated drinks
NSAIDS
Stress
Hiatus hernia
What is the surgical management for reflux?
Laproscopic fundoplication
What is famotidine?
Histamine Receptor 2 antagonist
