Gastro-oesophageal reflux disease (GORD) Flashcards
(6 cards)
Features
Heartburn
Acid regurgitation, esp. lying down at night
Water brash
Diagnosis
usually made on history
Investigation usually not needed
- reserve for danger signs and non-responsive Rx
—gastroscopy is the investigation of choice
Consider:
- barium swallow/meal
- 24 hr ambulatory oesophageal pH monitoring
Complications include
oesophagitis
stricture
iron-deficiency anaemia
respiratory (chronic cough, asthma)
Barrett oesophagus
Management
Stage 1
Patient education/appropriate reassurance
Consider acid suppression or neutralisation
Attend to lifestyle, inc. stress management:
- –weight reduction if overweight (this alone may abolish symptoms)
- –reduction or cessation of smoking
- –reduction or cessation of alcohol (esp. with dinner)
- –avoid trigger/fatty foods (e.g. pastries, fatty or spicy foods, caffeine, tomato products)
- –reduction or cessation of coffee, tea and chocolate
- –avoid coffee and alcohol late at night
- –avoid gaseous drinks
- –leave at least 3 h between evening meal and retiring
- –have main meal at midday with light evening meal
- –change or cease offending drugs (e.g. NSAIDs, calcium channel blockers)
Antacids: (suitable for daytime symptoms)
- –best is liquid alginate/antacid mixture e.g. Gaviscon/Mylanta plus 20 mL, on demand or 1½–2 h before meals and bedtime
Elevation of head of bed or wedge pillow:
- –If GORD occurs in bed, sleep with head of bed elevated 20–30 cm on wooden blocks or wedge pillow (preferable)
Management
Stage 2
Reduce acid secretion (select from):
H2-receptor antagonists (oral use for 8 wks)
- –ranitidine 150 mg bd pc or 300 mg nocte or
- –famotidine 20 mg bd or
- –nizatadine 150 mg bd
PPI for 4 wks (very effective for ulcerative oesophagitis and reflux) (select from):
- –omeprazole 20 mg mane or
- –lansoprazole 30 mg mane or
- –pantoprazole 40 mg mane or
- –esomeprazole 20 mg mane or
- –rabeprazole 20 mg mane
Note: May need to eradicate Helicobacter pylori if present.
