GORD Flashcards
1
Q
What is GORD?
A
This is the reflux of gastric contents into the oesophagus or beyond into the oral cavity or the lung.
GORD may occur with or without oesophageal inflammation (oesophagitis)
2
Q
What is erosive reflux disease?
A
This is GORD but erosions are present on endoscopy
3
Q
Causes of GORD
A
- More frequent LES relaxation causing reflux of gastric contents into the oesophagus.
- This is more common after meals and opening of the LES is stimulated by fat in the duodenum.
4
Q
Pathophysiology of GORD
A
- The severity of mucosal damage depends on duration of contact with gastric contents, characteristics of the gastric contents (acid, pepsin and bile salts) and resistance of the epithelium to damage.
- Reflux-induced asthma may be caused by chronic aspiration of reflux contents and vasovagal bronchoconstriction
5
Q
Signs and symptoms of GORD
A
Heartburn Acid regurgitation Atypical symptoms: Dysphagia Laryngitis Halitosis Bloating/early satiety Globus Enamel erosion Dyspepsia Chest pain
6
Q
Risk factors of GORD
A
FHx of heartburn or GORD Older age Hiatus hernia Obesity Smoking Alcohol Pregnancy Big meals Drugs such as TCAs, antidepressants, anticholinergics and calcium channel blockers Systemic sclerosis
7
Q
Investigations for diagnosis of GORD
A
PPI trial
Consider:
OGD
Oesophageal manometry
8
Q
Differentials of GORD
A
ACS Stable angina Achalasia Functional oesophageal disorder/functional heartburn Malignancy Peptic ulcer disease Laryngopharyngeal reflux Oesophageal spasm Oesophagitis Infection from CMV and candidiasis
9
Q
Management of GORD
A
Initial presentation- Standard-dose PPI (omeprazole 20 mg OD)- the first line Lifestyle changes such as weight loss, smoking cessation and reducing alcohol intake -Ongoing- PPI-responsive: Continued PPI Surgery (2nd) Incomplete response to PPI: High dose PPI
10
Q
Complications of GIRD
A
Oesophagitis
Anaemia
Oesophageal structure
Barrett’s oesophagus
