GORD and Hiatus Hernia

Question 1

What are causes of GORD?

Answer 1

Lower oesophageal sphincter hypotension, hiatus hernia, oesophageal dysmotility due to systemic sclerosis, obesity, gastric acid hypersecretion, delayed gastric emptying, smoking, alcohol, pregnancy, drugs like tricylcics, anticholis, nitrates, H.pylori

Question 2

What are typical symptoms?

Answer 2

Heartburn and regurgitation - PPI trial working is usually diagnostic. Extra-oesophageal symptoms include cough, laryngitis, asthma, or dental erosion.

Question 3

What are potential complications of GORD?

Answer 3

Oesophagitis, ulcers, benign stricture, iron deficiency
Metaplasia –> Neoplasia –> Dysplasia
Barret’s can develop which is metaplastic change of squamous epithelium to columnar

Question 4

What are risk factors for GORD?

Answer 4

family history of heartburn or GORD
older age
hiatus hernia
obesity

Question 5

How is GORD treated?

Answer 5

Start with PPI therapy
Potentially magnesium trisilicate
Avoid drugs affecting oesophageal motility like nitrates, anticholinergics or calcium channel blockers as these relax the lower oesophageal sphincter

Question 6

What tests can potentially be considered if PPI therapy doesn’t work

Answer 6

OGD if
Ambulatory 24h pH monitoring with manometry if endoscopy normal
Laparoscopic Nissen fundoplication if all else fails

Question 7

What is a sliding hiatus hernia?

Answer 7

GO junction slides up into chest and acid reflux common as LOS becomes less competent.

Question 8

What is a rolling hiatus hernia?

Answer 8

GO junction remains in abdomen put portion of stomach herniates into the chest alongside oesophagus.

Question 9

How can a hiatus hernia be imaged and treated?

Answer 9

Imaged via CT, OGD will only show mucosa but cannot reliably exclude hiatus hernia.
Treated by treating GORD/losing weight (obese women particularly at risk). While rolling can strangulate, risk dramatically drops after 65.