GORD, Barrett's Oesophagus, Oesophagitis

Question 1

What does GORD stand for?

Answer 1

Gastro-oesophageal Reflux Disease

Question 2

What are causes of GORD?

Answer 2

Incompetent LOS
Poor oesophageal clearance or barrier function
Visceral sesntivity
Increased abdominal pressure 
Gastric acid hypersecretion
Slow gastric emptying 
Overating 
Surgery in achalasia 
Drugs 
Systemic sclerosis

Question 3

What are causes of increased abdominal pressure increasing risk of GORD?

Answer 3

Obesity

Pregnancy

Question 4

What are the major risk factors for GORD?

Answer 4

Smoking
Alcohol
Weight

Question 5

Which drugs can cause GORD?

Answer 5

Tricyclics
Anticholinergics
Nitrates

Question 6

What is associated with systemic sclerosis in the GORD context?

Answer 6

H. pylori

Question 7

What is the pathological mechanism behind GORD?

Answer 7

Ulceration due to exposure

Question 8

GORD is graded according to?

Answer 8

Erosion

Question 9

What are the 4 grades of GORD?

Answer 9

Tiny erosion
> 5 mm
<75% affected
All affected

Question 10

How does GORD present?

Answer 10

Heartburn
Acid reflux 
Water brash (hyper-salivation) 
Dysphagia 
Odynophagia (pain on swallowing) 
Weight loss
Epigastric pain (mimic cardiac) 
Hoarseness
Cough 
Reflux bronchitis lying flat

Question 11

How do you investigate GORD?

Answer 11

Endoscopy
Barium swallow 
Oesophageal manometry
pH studies
Nuclear studies

Question 12

Where are possible complications of GORD?

Answer 12

Barrett's -> Oesophageal carinoma
Benign oesophageal stricture (Schatzki's rink)
Oesophagitis
Gastroparesis 
Achalasia
Hiatus hernia

Question 13

What is gastroparesis?

Answer 13

Delayed gastric emptying without physical obstruction

Question 14

What are symptoms of gastroparesis?

Answer 14

Feeling full / bloated
Nausea
Vomiting (food fear) 
Weight loss
Epigastric pain
Feeling bloated

Question 15

What are causes of gastroparesis?

Answer 15

Idiopathic 
DM
Cannabis
Medication
Systemic disease (systemic sclerosis)

Question 16

Which medications can cause gastroparesis?

Answer 16

Opiates

Anticholinergics

Question 17

How do you investigate gastroparesis?

Answer 17

Gastric emptying studies

Question 18

How do you manage gastroparesis?

Answer 18

Remove provokers
Liquid/sloppy diet
Eat little and often
Pro-motility agents
Gastric pacemaker

Question 19

How do you manage GORD?

Answer 19

If no erosion manage symptoms 
Lifestyle 
Antacid 
PPI
Surgery

Question 20

Which antacids can be given for GORD?

Answer 20

Magnesium trisillicate mixture

Gaviscon

Question 21

Which PPIs could be given for GORD?

Answer 21

Omeprazole

Lansoprozole

Question 22

How are PPIs like omeprazole absorbed?

Answer 22

Become active in acidic environment

Absorbed from GIT and delivered to secretory cancel of stomach where activated to sulferamide

Question 23

What is the mechanism of PPIs?

Answer 23

Modify membrane-inserted proton pumps

Inhibit acid secretion for 10-14 hours

Question 24

What is important for the timing of PPIs?

Answer 24

At least 40 minutes before meal

Question 25

PPIs only give full effect after?

Answer 25

Repeated dosing

Question 26

What are PPIs used for?

Answer 26

Peptic ulcers GORD Zollinger-Ellison Syndrome

Question 27

What is the surgical option for GORD?

Answer 27

Nissen Fundoplication Tighten valve to prevent oesophagitis (unlikely to be effective in severe/unresponsive disease)

Question 28

What is Barrett's Oesophagus?

Answer 28

Irreversible (unless ablated) metabplastic change from stratified squamous to columnar epithelium as a protective response to persistent reflux of acid/bile

Question 29

Barrett's oesophagus moves the _______ more proximal

Answer 29

squamo-columnar junction (Z-line)

Question 30

What are the risk factors for Barrett's oesophagus?

Answer 30

``` GORD Hiatus hernia Obesity Smoking Alcohol ```

Question 31

What is the pathological pathway to Barrett's oesophagus and possible complication?

Answer 31

Norma Oesophagitis Barrett's Oesophagus Adenocarcinoma

Question 32

How do you manage Barrett's?

Answer 32

Lifestyle advice Radiofrequency ablation PPIs Oesophagectomy

Question 33

What causes acute oesophagi's?

Answer 33

Chemical ingestion (bleach, caustic substances) or infectious agent (candidiasis, herpes, CMV) in immunocompromised patients)

Question 34

What type of inflammation occurs with allergic oesophagi's?

Answer 34

Eosinophilic

Question 35

What are risk factors for allergic oesophagitis?

Answer 35

Personal or FHx of atopy Asthma being young

Question 36

What are investigations for allergic oesophagitis?

Answer 36

pH probe negative for reflux Increased eosinophils in blood Corrugated 'feline' or 'spotty' oesophagus

Question 37

How do you treat allergic oesophagitis?

Answer 37

Steroids | Cromoglycate +/- Montelukast