GORD

Question 1

(4) etiologies of GORD

Answer 1

• Reduced motility in esophagus
• failed lower esophagus sphincter
• increased abdominal pressure below (pregnancy, ascites) & slow gastric emptying
• more injurious agents (H. pylori, more acid)

Question 2

2 classifications of GORD

Answer 2

ERD: erosive reflux disease (ulcers)
NERD: non-erosive reflux disease

Question 3

How can esophagus be damaged in GORD (5)?

Answer 3

• Esophagitis
• Barett’s esophagus
• Strictures
• Mallory-Weisse tears
• Esophageal carcinoma

Hence ask about dysphagia & odynophagia

Question 4

(4) Extra-esophageal Cx of GORD

Answer 4

• aspiration pneumonia
• laryngitis
• exacerbation of asthma
• dental erosions

Question 5

What makes GORD worse?

Answer 5

• night: supine & lower resting lower esophageal sphincter tone

Question 6

What determines severity of GORD (3)?

Answer 6

• frequency & duration of episodes
• gastric content itself (supraacidic etc)
• epithelial resistance

Question 7

Things to ask in GORD Hx

Answer 7

Increased intraabdo pressure as a trigger
Worse after Meal times
Heart burn (pain)
Acid regurgitation

Question 8

How do you Dx GORD?

Answer 8

• Clinical Dx
• Give PPI for 8 weeks and see if symptoms improve
• Do H. pylori test if dyspeptic as well
• do a gastroscopy on people who are still symptomatic on PPI
• Barium swallow if hernia suspected

Question 9

Rx of GORD

Answer 9

• Lifestyle changes: reduced obesity & sleeping with the head elevated.
• Pantoprazole/PPI
• antacids/H2 blockers/alginates
• Surgery if very severe: fundoplication (wrapping around fundus of stomach around esophagus)

Question 10

Which drugs predispose to GORD?

Answer 10

beta blockers
alpha blockers
calcium channel blockers
anticholinergics
nitrates

bisphosphonates
theophyline