GORD Flashcards
1
Q
Pathophys GORD
A
- LOS controls passage of oesophagus contents into stomach
- Episodic relaxation is expected in normal function
- In GORD, these episodes become more frequent and allow reflux of contents into oesophagus
2
Q
Problem with reflux
A
- Refluxed acidic contents = inflammation of oesophageal mucosa
- Hiatus hernia can increase reflux episodes - sphincter disturbed
3
Q
RF GORD
A
- Obesity
- Smoking
- Alcohol intake
- Pregnancy
- Male gender
4
Q
Symptom of GORD
A
- Chest pain - burning retrosternal sensation
- Worse after meals/lying down/bending over or straining
- Relieved by antacids
- Others inc belching, water brash sensation (sour taste), nocturnal/chronic cough
5
Q
Red flag symptoms associated with GORD you should always check
A
- Dysphagia
- Weight loss
- Early satiety
- Malaise
- Loss of appetite
6
Q
Classification of reflux
A
- Los Angeles classification - based on severity of endoscopic findings of mucosal breaks in distal oesophagus
7
Q
Los Angeles classification of GORD
A
- Grade A - breaks 5mm or less
- B - more than 5mm
- C - extending between 2 or more mucosal folds but less than 75% circumference
- D - circumferential breaks 75% or more
8
Q
Urgent referral criteria 2WW for suspected upper GI cancer
A
- Any patient with dysphagia
- Any patient >55yrs with weight loss and upper GI pain, dyspepsia or reflux
- Patients with persistent symptoms despote conservative management
9
Q
Normal resolution of GORD
A
- Clinical diagnosis
- Trial of PPI settles symptoms
10
Q
Gold standard diagnosis for GORD
A
24hr pH monitoring - can quantify burden of reflux and is important when medical treatment has failed and surgery is considered
11
Q
Imaging for GORD - when and what
A
- If persistent or red flag symptoms patients often have upper GI endoscopy
- Rules out malignancy and assess for Barretts and hiatus hernia
- Oesophageal manometry if severe to exclude dysmotility of oesophagus
12
Q
What is done with pH monitoring?
A
- Assess amount of time acid is present in oesophagus and correlation of presence and symptoms
- Produces algorithmic score called DeMeester score - determine symptom and reflux correlation
13
Q
Conseravative management GORD
A
- Avoid precipitators - alcohol, coffee, fatty foods
- Weight loss
- Smoking cessation
14
Q
Medical management GORD
A
- PPIs - long term usually
15
Q
Indications for anti-reflux surgery
A
- Failure to respond or only partial response to medical therapy
- Patient preference - avoid life long medication
- Patients with complications of GORD - eg recurrent pneumonia
