Gastro Oesophageal Reflux Disease Flashcards
What is it?
Reflux of gastric acid (and bile) in oesophagus
What is the pathogenesis?
Thickening of squamous epithelium
Ulceration of oesophageal epithelium when severe reflux
What are the risk factors?
Pregnancy Obesity Drugs lowering LOS pressure Smoking Alcoholism
What is the presentation?
Heartburn Cough Water brash Acid brash Odynopahgia
How is it investigated?
Endoscopy: the majority of patients with reflux symptoms have no visible evidence of oesophageal abnormality when endoscopy is performed, HOWEVER, endoscopy must be performed in the presence of ALARMS features suggestive of malignancy
pH-metry: nasal catheter containing pH sensors at both sphincters (UOS and LOS)
What are ALARMS features?
Anaemia Loss of weight Anorexia Recent onset/progressive symptoms Melaena/haematemesis or mass Swallowing difficulty
How is it diagnosed?
The typical reflux syndrome can be diagnosed on the basis of the characteristic symptoms, without diagnostic testing
What are the treatments/management options?
Lifestyle measures: weight loss, smoking cessation, small +regular meals, reduce alcohol, raise bed height at night
Pharmacological: alginates (Gaviscon), proton pump inhibitors (omeprazole), H2 receptor antagonist (Ranitidine)
For refractory symptoms FOLLOWING investigation (e.g. endoscopy): anti-reflux surgery (fundoplication: full/partial warp)
What are the complications?
Healing by fibrosis: stricture formation, impaired oesophageal motility, oesophageal obstruction
Oesophagitis
Barrett’s Oesophagus
Oesophageal Cancer
What are the causes?
Hiatus hernia
Hypotensive LOS
Delayed gastric emptying
Delayed oesophageal emptying
What are the causes?
Hiatus hernia
Hypotensive LOS
Delayed gastric emptying
Delayed oesophageal emptying
What are the side effects of hiatus hernia repair and fundoplication?
Dysphagia
Difficulty to belch and vomit
Gas bloating
