Gastro-oesophageal reflux disease (GORD) Flashcards Preview

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Flashcards in Gastro-oesophageal reflux disease (GORD) Deck (8)
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1

Define Gastro-oesophageal reflux disease (GORD)

A condition which develops when the reflux of the stomach contents cuses troublesome symptoms (ie at least two heartburn episodes per week) and/or complications

2

What may predispose you to GORD?

  • Lower oesophageal sphincter hypotension
  • Hiatus hernia
  • Loss of oesophageal peristaltic function
  • Abdominal obesity
  • Gastric acid hypersecretion
  • Delayed gastric emptying
  • Overeating
  • Smoking
  • Alcohol
  • Pregnancy
  • Surgery in achalasia
  • Drugs (tricyclics, anticholinergics, nitrates)
  • Systemic sclerosis
  • Helocobacter pylori??

3

What are the symptoms of GORD?

Oesophageal;

  • Heartburn Iburning, retrosternal discomfort related to meals, lying down, stooping & straining, relieved by antacids)
  • Belching
  • Acid brash (acid or bile regurgitation)
  • Waterbrash (excessive salivation)
  • Odynophagia (painful swalling, eg from oesophagitis or ulceration)

Extra-oesophageal;

  • Nocturnal asthma
  • Chronic cough
  • Laryngitis (hoarseness, throat clearing)
  • Sinusitis

4

What are complications of GORD?

  • Oesophagitis
  • Ulcers
  • Benign stricture
  • Barrett's oesophagus (the epithelium of the distal oesophagus undergoes metaplasia from squamous to columnar type. Endoscopic appearance is 'velvety' epithelium)
  • Oesophageal adenocarcinoma
  • Iron-deficiency anaemia (rare)

5

What, therefor, are some differential diagnosis of GORD?

  • Oesophagitis (corrosives, NSAID)
  • Infection (CMV, herpes, Candida)
  • Dudodenal/ gastric ulcers or cancer
  • Non-ulcer dyspepsia

6

What investigations would you perform to diagnose GORD?

  • Upper GI endoscopy, if;
    • >55yrs
    • Symptoms >4weeks
    • Dysphagia
    • Persistent symptoms despite treatment
    • Relapsing symptoms
    • Weight loss
  • Barium swalling may show hiatus hernia
  • 24hr oesophageal pH monitoring +/- manometry (if endoscope is normal)

7

How would you treat GORD?

Lifestyles;

  • Encourage weight loss, Xsmoking, raise head in bed, small/regular meals
  • Avoid hot drinks, alcohol, citrus fruits, tomatoes, onions, carbonated beverages, spicy foods, coffee, tea, chocolate & eating <3hrs before bed
  • Avoid drugs
    • Red. oseophageal motility; nitrates, anticholinergics, tricyclic antidepressants, calcium channel blockers
    • Damage mucosa; NSAIDs, K+ salts, biphosphonates

Drugs;

  • Antacids (magnesium trisilicate mixture)
  • Alginates (Gavicon Advance)
  • Oesophagitis; PPI (lansoprazole)

Surgery;

  • Nissen fundoplication (wrap stomach around oesophagus so when it contracts it closes oesophagus preventing acid reflux)
  • Only if severe

8

Outline the Los Angeles (LA) classification of GORD

There are 4 grades;

  1. >=1 mucosal break/s <5mm long not extending beyond 2 mucosal fold tops
  2. Mucosal break >5mm long limited to the space between 2 mucosal fold tops
  3. Mucosal break continuous between the tops of 2 or more mucosal folds but which involves less than 75% of the oesophageal circumference
  4. Mucosal break involving >=75% of the oesophageal circumference