Gastro-oesophageal reflux disease

Question 1

What is GORD?

Answer 1

acid from stomach refluxes through lower oesophageal sphincter and irritates lining of oesophagus

Question 2

why is oesophagus sensitive to acid?

Answer 2

squamous epithelium lining

Question 3

why is acid more protected from acid?

Answer 3

columnar epithelium lining

Question 4

presentation of GORD

Answer 4

heartburn 
acid regurgitation 
retrosternal or epigastric pain 
bloating 
nocturnal cough 
hoarse voice

Question 5

what can endoscopy be used to assess for?

Answer 5

peptic ulcers, oesophageal or gastric malignancy

Question 6

patients with evidence of GI bleed

Answer 6

urgent endoscopy

Question 7

red flags

Answer 7

dysphagia
age over 55
weight loss 
upper abdo pain/reflux
treatment resistant dyspepsia
nausea and vomiting
low haemoglobin 
raised platelets

Question 8

lifestyle advice

Answer 8

reduce caffeine and alcohol
weight loss
smaller meals 
avoid eating before bed
stay upright after meals 
stop smoking

Question 9

medications

Answer 9

acid neutralising eg gaviscon and rennie
PPI eg omeprazole
ranitidine (H2 receptor antagonist)
surgery

Question 10

surgery for GORD

Answer 10

laparascopic fundoplication

tying fundus around LOS

Question 11

H. pylori

Answer 11

gram negative aerobic bacteria

lives in stomach

Question 12

what can H. pylori cause?

Answer 12

gastritis, ulcers and stomach cancer

Question 13

H. pylori actions

Answer 13

forces way into gastric mucosa and creates breaks

produce ammonia to neuralise the acid

Question 14

PPI and H.pylori test

Answer 14

stop PPI for 2 weeks - ensure accurate result

Question 15

H pylori tests

Answer 15

urea breath test - C13
stool antigen test
rapid urease test during endoscopy

Question 16

rapid urease test

Answer 16

during endoscopy
small biopsy of mucosa and add urea
if present produce ammonia making more alkali

Question 17

eradication of H.pylori

Answer 17

triple therapy
PPI and 2 antibiotics
amoxicllin and clarithromycin 7 days

Question 18

barretts oesophagus

Answer 18

constant acid refluc leads to metaplasia from squamous to columnar epithelium

Question 19

barretts oesophagus risk

Answer 19

pre-malignant

risk factor for adenocarcinoma of oesophagus

Question 20

change from barretts oesophagus to cancer

Answer 20

low grade dysplasia
high grade dysplasia
adenocarcinoma

Question 21

treating barretts oesophagus

Answer 21

PPI

ablation therapy using laser, cryotherapy or photodynamic therapy

Question 22

2 types of hiatus hernia

Answer 22

sliding - stomach slides up along with oesophagus through diaphragm
rolling - fundus folds around and enters through diaphragm

Question 23

diagnosing hiatus hernia

Answer 23

barium swallow
endoscopy
CT thorax
oesophageal manometry/pH monitoring