Gastro-oesophageal reflux disease Flashcards
(23 cards)
What is GORD?
acid from stomach refluxes through lower oesophageal sphincter and irritates lining of oesophagus
why is oesophagus sensitive to acid?
squamous epithelium lining
why is acid more protected from acid?
columnar epithelium lining
presentation of GORD
heartburn acid regurgitation retrosternal or epigastric pain bloating nocturnal cough hoarse voice
what can endoscopy be used to assess for?
peptic ulcers, oesophageal or gastric malignancy
patients with evidence of GI bleed
urgent endoscopy
red flags
dysphagia age over 55 weight loss upper abdo pain/reflux treatment resistant dyspepsia nausea and vomiting low haemoglobin raised platelets
lifestyle advice
reduce caffeine and alcohol weight loss smaller meals avoid eating before bed stay upright after meals stop smoking
medications
acid neutralising eg gaviscon and rennie
PPI eg omeprazole
ranitidine (H2 receptor antagonist)
surgery
surgery for GORD
laparascopic fundoplication
tying fundus around LOS
H. pylori
gram negative aerobic bacteria
lives in stomach
what can H. pylori cause?
gastritis, ulcers and stomach cancer
H. pylori actions
forces way into gastric mucosa and creates breaks
produce ammonia to neuralise the acid
PPI and H.pylori test
stop PPI for 2 weeks - ensure accurate result
H pylori tests
urea breath test - C13
stool antigen test
rapid urease test during endoscopy
rapid urease test
during endoscopy
small biopsy of mucosa and add urea
if present produce ammonia making more alkali
eradication of H.pylori
triple therapy
PPI and 2 antibiotics
amoxicllin and clarithromycin 7 days
barretts oesophagus
constant acid refluc leads to metaplasia from squamous to columnar epithelium
barretts oesophagus risk
pre-malignant
risk factor for adenocarcinoma of oesophagus
change from barretts oesophagus to cancer
low grade dysplasia
high grade dysplasia
adenocarcinoma
treating barretts oesophagus
PPI
ablation therapy using laser, cryotherapy or photodynamic therapy
2 types of hiatus hernia
sliding - stomach slides up along with oesophagus through diaphragm
rolling - fundus folds around and enters through diaphragm
diagnosing hiatus hernia
barium swallow
endoscopy
CT thorax
oesophageal manometry/pH monitoring
