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Flashcards in GORD Deck (20):
1

What percentage of the population are affected by GORD?

30%

2

Pathophysiology of GORD:

Reflux of gastroduodenal contents up into the oesophagus

Chronic exposure of oesophageal mucosa to this

Results in oesophagitis in a proportion of cases.

3

Aetiological factors in GORD:

* LES hypotension
* Increased IA Pressure
* Hiatus hernia
* Oesophageal dysmotility
e.g. Systemic sclerosis
* Gastric acid hypersecretion
* Delayed gastric emptying

4

Risk Factors for GORD:

* Obesity
* Pregnancy
* Fat, Chocolate, Coffee or alcohol
* Large meals
* Smoking
* Drugs
Anticholinergics
Tricyclics
Nitrates
CCBs
* Hiatus hernia
* Surgery for achalasia of cardia

5

Oesophageal symptoms of GORD:

Oesophageal Sx

- Heartburn
Burning
Retrosternal discomfort

After:
Meals
Lying
Stooping or straining

Relieved by:
Antacids

- Belching
- Acid brash
- Waterbrash
- Odynophagia (severe oesophagitis)

6

Extraoesophageal Sx of GORD:

* Nocturnal asthma (wheeze, SOB)
* Chronic cough
* Hoarseness
Cherry-Donner syndrome
* Sinusitis
* Atypical chest pain

7

Red flag features in GORD:

ALARMS

Anaemia (IDA)
Loss of weight
Anorexia
Recent onset/progressive
Melaena/haematemesis
Swallowing difficulty
(Dysphagia/Odynophagia)

8

Signs of GORD:

Usually none

May be able to hear a succussion splash (delayed gastric emptying)

9

Differential diagnosis of GORD:

* Oesophagitis
* Infection
* Peptic ulcer
* Gastric/Duodenal Ca
* Non-ulcer dyspepsia
* Oesophageal spasm
* Cardiac disease

10

Who should be given endoscopy in GORD?

* Dysphagia

OR

* >55 + ALARMS Sx

OR

* Treatment refractory Sx

11

Investigations for GORD:

1. Endoscopy

2. Bloods (FBC ?IDA)

3. Barium swallow (?HH)

4. H. pylori testing

5. Oesophageal pH monitoring (+/- manometry)

12

What is the gold standard investigation for diagnosing GORD when endoscopy is normal?

Oesophageal pH monitoring +/- manometry

13

Lifestyle management of GORD:

* Weight loss
* Smoking cessation
* Small, regular meals
* Reduce hot drinks
* Reduce alcohol
* Reduce acidic foods
* Reduce spicy foods
* Reduce caffeine
* Avoid eating <3h b4 bed
* Raise the bed head

14

Pharmacological management of GORD:

1. Antacids

2. + PPI

3. + H2RA

15

Which drugs affect oesophageal motility?

Anticholinergics
Tricyclics
Nitrates
Ca-channel blockers

16

Which drugs may damage the oesophageal mucosa?

NSAIDs
K+ salts
Bisphosphonates

17

Surgical management of GORD aims to do what?

Raise the resting tone of the LES

18

Surgical management of GORD:

* Laparoscopic Nissen fundoplication

* Laparoscopic insertion of magnetic bead band

* Rf-induced hypertrophy

19

Complications of GORD:

* Oesophagitis
* Ulcers
* Benign strictures
* IDA
* Barrett's oesophagus
* Oesophageal Ca

20

What is Barrett's and what risk of transformation is there?

Oesophageal metaplasia squamous -> glandular columnar

0.1-0.4% risk per annum