GastroOesophageal Reflux Disease Flashcards
What is GORD
the inflammation of the oesophagus as a result of acid reflux or bile
aetiology of GORD
the disruption of mechanisms that prevent reflux
what mechanisms prevent reflux
LOS, acute angle of junction, mucosal rosette and the diaphragm
what is the mucosal rosette
Redundant mucosal folds are present at gastro-esophageal junction only when a normal angle of His is present. These folds squeeze together to form a weak antireflux valve.
epidemiology of GORD
COMMON; 5-10% adults
risk factors for developing GORD
family history of reflux or heartburn, old age, hiatus hernia and obesity, smoking, NSAIDs and drugs that slow down LOS function
presenting symptoms
heartburn, acid regurgitation, substernal/epigastric burning discomfort, water brash, aspiration and dysphagia, bloating
what aggravates the symptoms of GORD
lying supine, late and large meals, bending, drinking alcohol
physical examination
usually normal. occasionally there may be some epigastric tenderness and a wheeze upon auscultation and dysphonia
why can dysphonia present in someone with GORD
the acid that comes up the oesophagus can irritate the larynx
investigations to consider and perform
upper GI endoscopy, biopsy and cytological brushings; these confirm the presence of oesophagitis and allows you to exclude malignancy
ambulatory pH monitoring
barium swallow; can detect hiatus hernia, peptic stricture and extrinsic oesophagus compression
CXR; not specific for GORD but can show a hiatus hernia
management of acute presentation of GORD
PPI; omeprazole 20mg daily
lifestyle changes
what advice (conservative management)
weight loss, elevating head of bed, stop smoking, lower fat meals, AVOID eating too late
medical management
antacids, alginates, H2 antagonists, PPI’s
why will an annual endoscopy be done in those with GORD
annual surveillance to check for Barrett’s Oesophagus
