GORD

Question 1

What is GORD?

Answer 1

Stomach contents leaks back from stomach into oesophagus

Question 2

Which foods aggravate GORD?

Answer 2

• EtOH
• Caffeine
• Spicy/fatty/fried foods
• Tobacco
• Chocolate
• Peppermint
• Citrus fruit juices

Question 3

Aetiology of GORD?

Answer 3

-Inappropriate transient relaxation of lower oesophageal sphincter.
-Zollinger Ellison syndrome
Contributing fx: delayed oesophageal clearance, delayed gastric emptying, increased intra-abdominal pressure.

Question 4

What is Zollinger Ellison syndrome?

Answer 4

Gastrin secreting neuroendocrine tumour triggering gastric acid hypersecretion

Question 5

CFx GORD?

Answer 5

• Heartburn (pyrosis)
• Acid regurgitation
• +/- sour regurgitation, lump in throat (bolus sensation) and frequent belching.

Question 6

How is GORD diagnosed?

Answer 6

Clinical diagnosis based on Hx and relief following trial of PPI

Question 7

Indications for gastroscopy?

Answer 7

• Heartburn + red flags (bleeding / weight loss etc)
• No relief post 4-8/52 trial of PPI
• Hx of oesophageal stricture with persistent dysphagia

Question 8

When is oesophageal manometry indicated?

Answer 8

Pre surgical fundoplication to ensure oesophagus functional (more likely successful in lower oesophageal pressure is diminished)

Question 9

Mx of GORD?

Answer 9

Lifestyle: 
-Relief of symptoms through food trigger avoidance
-Weight loss
-Bed head elevation
Rx: PPI
Surgical: fundoplication

Question 10

Complications of GORD?

Answer 10

• Oesophageal stricture
• Ulcer
• Bleeding
• Barrett’s Oesophagus

Question 11

How may GORD precipitate dysphagia?

Answer 11

Reflux related oesophageal stricture

Question 12

How is reflux related stricture diagnosed?

Answer 12

Gastroscopy: confirms diagnosis and excludes malignancy; therapeutic stricture dilation

Question 13

Treatment of reflux related oesophageal stricture?

Answer 13

• Dilate stricture at gastroscopy

- Treat cause: PPI, fundoplication.

Question 14

Features of GORD on nasa-oesophageal pH monitor?

Answer 14

Check for pH

Question 15

Alternative to naso-oesphageal pH monitor?

Answer 15

Bravo pH capsule: clipped to side of oesophagus. Measures pH for 48h.

Question 16

Outcomes of anti-reflux surgery?

Answer 16

-80-90% good long term outcomes

Question 17

Side effects of antireflux surgery?

Answer 17

• Inability to burp or vomit
• Increased flatus
• Bloating