GORD

Question 1

GORD most common in which age group

Answer 1

Over 40

Question 2

How does pregnancy affect GORD

Answer 2

increase risk

Question 3

What gender is more susceptible to GORD complications

Answer 3

Males

Question 4

Risk factors for GORD

Answer 4

Family Hx, obesity, smoking, alcohol, medication, foods, pulmonary conditions, depression, anxiety

Question 5

What happens in spontaneous transient LES relaxation

Answer 5

LES dilates when we eat or vomiting/belching

Question 6

Factors that increase spontaneous transient LES relaxation

Answer 6

Being bedridden, more volume in stomach, pressure on stomach

Question 7

Factors that increase intra-abdominal pressure

Answer 7

Constipation, bending down, cough, pregnancy, eating, obesity

Question 8

Why does GORD incresae during pregnancy

Answer 8

Increased intra-abdominal pressure and hormones

Question 9

Defects in natural defence mechanisms

Answer 9

Anatomical position, oseophageal clearance and mucosal resistance, factors that cause delayed gastric emptying, increased gastric volume

Question 10

Why does GORD happen more commonly at night and in older people

Answer 10

Reduced saliva production

Question 11

Factors that delay gastric emptying

Answer 11

High fat foods and smoking

Question 12

Factors that increase gastric volume

Answer 12

Eating a large amount, excess stomach acid secretion, fluids from other areas entering the stomach, decreased rate of emptying

Question 13

Foods that may cause GORD

Answer 13

Fatty foods, caffiene, garlic, onions, alcohol, spicy foods, orange juice

Question 14

Medications that may cause GORD

Answer 14

Anticholinergics, barbiturates, caffeine, tetracycline, aspirin, NSAIDs, iron, quinidine, DH CCBs

Question 15

Signs and symptoms of GORD

Answer 15

Burning sensation, burping, more common at night, triggered by bending down

Question 16

Red flag GORD symptoms

Answer 16

Dysphagia, odynophagia, hypovolaemia, unexplained weight loss

Question 17

Complications of GORD

Answer 17

Narrowing of the oesophagus, Barrett’s oesophagus (pre-malignancy)

Question 18

Indications for endoscopy in GORD

Answer 18

Anaemia, dysphagia, haematemeis +/- melaena, vomiting, weight loss

Question 19

Lifestyle advice for mild/intermittent GORD

Answer 19

Avoid trigger foods, go through medications to see if these could cause it, weight loss, smaller frequent portions, drink water between meals not during, elevate head in sleep, stop smoking

Question 20

Food and drinks that may exacerbate GORD

Answer 20

Caffeine, spicy food, citrus fruit, raw onion, chocolate, tomatoes, fatty food, alcohol

Question 21

1st line Tx for mild intermittent GORD

Answer 21

Antacid + alginate preparation prn (1) or MgOH + AlOH prn (2)

Question 22

Are antacids more effective as liquid or solid

Answer 22

Liquid as quicker onset of action

Question 23

Antacids that cause constipation

Answer 23

AlOH, CaCO3

Question 24

Antacids that cause flatulence

Answer 24

CaCO3

Question 25

Antacids that cause diarrhoea

Answer 25

MgOH

Question 26

Antacids with cardiac effects

Answer 26

Sodium bicarb

Question 27

1st line Tx of mild intermittent symptoms if not resolved with antacid

Answer 27

H2 receptor antagonist or PPI prn

Question 28

Examples of H2 receptor antagonists

Answer 28

Famotidine or nizatidine

Question 29

Examples of PPIs

Answer 29

Esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole

Question 30

Low dose PPI

Answer 30

Half standard dose

Question 31

High dose PPI

Answer 31

Twice standard dose

Question 32

Side effects of PPIs

Answer 32

Well tolerated, osteoporosis, kidney nephritis, pneumonia, hypomagnesemia, malabsorption

Question 33

Is it better to give PPI before breakfast or dinner

Answer 33

If majority of symptoms during the day before breakfast, if majority at night before dinner

Question 34

Taking PPI at standard dose for 4-8wks but no improvement

Answer 34

Check compliance, step up to high does, endoscopy to make sure it is GORD, can add H2 antagonist

Question 35

GORD management in pregnancy

Answer 35

Healthy lifestyle, antacid safe in pregnancy, refer to Dr

Question 36

Is PPI effective for f(x) heartburn

Answer 36

Ineffective as acid is not the problem

Question 37

Is PPI effective for f(x) dyspepsia

Answer 37

Marginally effective

Question 38

Management for f(x) heartburn or dyspepsia

Answer 38

Cognitive behavioural therapy, hypnotherapy, TCA