GORD

Question 1

What is GORD

Answer 1

inflammation of esophagus caused by gastric acid/bile
Disruption of mechanisms that prevent reflux

Question 2

What would someone with GORD present with

Answer 2

Heartburn- after meals, alcohol,lying supine or bending over

-Acid regurgitation
- Increased saliva
-Pain is relieved by anatcids
-Aspiration - hoarseness,laryngitis,nocturnal cough, wheeze
- Dysphagia

Physical examination is usually normal but may have epigastric tenderness and a wheeze

Question 3

What investigations are done

Answer 3

-Resolution of symptoms after 8 week PPI trial
-OGD

-Oesophageal manometry with pH monitoring if OGD is inconclusive

Question 4

When is an OGD performed

Answer 4

if >55 , symptoms for a month or persistent dysphagia , relapse or weight loss

Question 5

What will the oesophageal manometry show

Answer 5

Low pressure at lower oesophageal sphincter

Question 6

What is the lifestyle management

Answer 6

Weight loss
elevate head
avoid provoking factors
stop smoking
lower fat intake
avoid large meals in the evening

Question 7

What is the medical management

Answer 7

PPI - eg lansoprazole for a month
- low dose if response

-if no response but endoscopically proven oesophagitis - double does for a month

• if no response but endoscopically negative , H2RA or prokinetic for 1 month
• Antacids for symptom relied

Question 8

What is surgical manegement

Answer 8

• Uncommon but increasing LOS pressure
  -Nissen fundoplication

Question 9

What are some complications of GORD

Answer 9

• esophagitis
  -ulcers
  -anaemia
  -benign stricture
  -barrett’s oesophagus
  -oesophageal carcinoma

Question 10

What are some risk factors of GORD

Answer 10

family history of heartburn
older age
hiatus hernia
obesity

Question 11

What is the first line of treatment for someone with dyspepsia symptoms with no alarming feature

Answer 11

PPI

Endoscopy should then be considered if patient has persistent symptoms despite adequate trial of PPI therapy / develops new alarm features