Flashcards in GORD Deck (18):
Reflux of gastric contents into the oesophagus is normal
GORD is said to occur when this causes symptoms.
What may prolonged/ excessive reflux cause?
Benign oesophageal strictures
Causes of GORD?
Lower oesophageal sphincter hypertension
Hiatus hernia (stomach squeezes into thorax via diaphragm hiatus)
Gastric acid hyper-secretion
Slow gastric emptying
Risk factors for GORD
Surgery on oesophagus
Drugs: tricyclic antidepressant, anticholinergics, nitrates
Describe pathophysiology of GORD?
Lower oesophageal sphincter (LOS) tone is reduced, and there are frequent transient LOS relaxations
Increased mucosal sensitivity to gastric acid
Reduced oesophageal clearance of acid
Delayed gastric emptying and prolonged post-prandial and nocturnal reflux also contribute
What oesophageal symptoms present clinically?
Heartburn – burning, retrosternal discomfort after meals, lying, stooping or straining, relieved by antacids
Odynophagia- painful swallowing (due to ulceration or oesophagitis)
What extra oesophageal symptoms present clinically
Laryngitis (hoarseness and throat clearing)
Complications of GORD?
Metaplasia—> dysplasia—> neoplasia
Differential Diagnosis of GORD
Oesophagitis from corrosives, NSAIDs, herpes, Candida
Duodenal or gastric ulcers/ cancers
Sphincter of Oddi (in ampulla of Vater) malfunction
Diagnostic tests and results
Endoscopy if alarm signs for upper GI malignancy
Barium swallow may show hiatus hernia
24 hour oesophageal ph monitoring will help diagnose GORD if endoscopy is normal
What lifestyle changes are advised as management for GORD?
Avoid excess alcohol/ aggrevating food
raising bed head
What medical treatment is given to patients with GORD?
Alginates- form a foam raft on gastric contents
H2- receptor antagonists
PPIs inhibit gastric H+/K+-ATPase, blocking luminal secretion of gastric acid
Name a H2 receptor antagonist
How do antacids work?
Contain alkaline ions
What surgical options are available in severe GORD
laparoscopic (key hole)
Aims to increase resting pressure in lower oesophageal sphincter
What is a Mallory- Weiss tear?
Persistant vomiting/ retching causes haematemesis via oesophageal mucosal tear.
What is a mallory weiss tear associated with?
alcoholism and eating disorders