GORD Flashcards
Define GORD
Dysfunctional relaxation of the lower oesophageal sphincter (LOS) that allows the acidic gastric contents to reflux into oesophagus leading to heartburn.
List the symptoms of GORD
Heartburn, Acid reflux, Chest pain, Feeling pain, Upper abdominal discomfort, Bloating, Difficulty swallowing, sensation of a lump in throat.
Describe the frequency/pattern of GORD symptoms
Nocturnal/ episodic
What can aggravate these symptoms?
Meals and reclining positions
Describe the GORD mechanisms
- Produced by generation of transient lower oesophageal sphincter relaxation (TLOSRs) in the absence of swallowing.
- TLORs arise from stimulation of gastric vagal mechanoreceptors allowing gastric acid, pepsin and bile to contact oesophagus epithelium.
- Oesophagul hypo-motility and abnormal oesophageal contractility can occur.
Describe the pathogenesis of GORD
- lOS barrier impairment
- TLOSRs
- Low resting LOS pressure
- Increased gastric pressure
- Decreased clearance of refluxed materials
- Decreased mucosal resistance
Give 3 examples of foods that contribute to decreased LOS pressure
Chocolate
Alcohol
Coffee
Give 3 examples of food/medicines that irritate gastric mucosa
Coffee
Spicy food
NSAIDs
Give 2 contributing factors that stimulate acid secretions
smoking
alcohol
List the 2 clinIcal groups of GORD
- Non-erosive reflux disease
- Erosive oesophagitis
- Barrett’s oesophagus
Define erosive oesophagitis
Acute inflammatory Th-cell 1 response associated with oesophageal injury
Describe the cause of reflux cough and reflux asthma
Micro aspiration of gastric contents into the lungs
Who is Barrett’s syndrome most prevalent in?
adult caucasian males
What disease does Barrett’s syndrome increase the risk of?
Oesophageal adenocarcinoma
List the red flags of Barrett’s oesophagus
Bleeding, unexplained weight loss, choking, chest pain, dysphagia
State the aim of GORD therapy
Treat symptoms, reduce frequency of episodes and duration
What are the therapeutic aims of treatment?
- Increases LOS pressure
- Enhance oesophageal mucosa
- Decrease acidity
- Decrease gastric volume available for reflux
List and describe the phases of treatment
Phase I - lifestyle, OTC meds - antacids, H2RAs, PPIs
Phase II - pharmacological interventions - Rx H2RAs and PPIs
Phase III - Surgical interventions
What drugs should be avoided in Pts with GORD and what should be considered?
AVOID: NSAIDs
CONSIDER: drugs likely to reduce LOS pressure CCBs and SSRIs
Describe the NICE guidelines for treatment of GORD symptoms
- Offer PPI for 4/8 weeks - no response offer H2RA
- If severe PPI for 8 weeks - no response offer a different PPI.
Describe the treatment in pregnancy
- 1st line - dietary and lifestyle
- Antacids/alginate
- PPI/H2RA
Give examples of antacids
MgCO3, ALCOS, CaCO3
What are the effects of Mg and Al containing preparations and describe how can this be overcome?
Mg - causes diarrhoea
Al - constipation
Take Mg & Al containing antacids decreases these colonic effects
When should antacids be taken to have prolonged effect?
After food - less effective due to rapids gastric emptying