GORD

Question 1

Definition

Answer 1

Clinical diagnosis: symptoms caused by reflux of gastric content into oesophagus and beyond (lung, oral cavity).

Question 2

Complications of GORD (5)

Answer 2

Oesophagitis

Barrett’s oesophagus

Aspiration of reflux contents

Dental erosions

Laryngitis

Question 3

Signs and symptoms of GORD

Answer 3

Common

• Heartburn
• Acid regurgitation

Less common

• Dysphagia
• Halitosis
• Enamel erosion
• Laryngitis
• Bloating

Question 4

Risk factors for GORD (4)

Answer 4

Older age

Family Hx

Obesity

Hiatus hernia

Question 5

Investigations for GORD

Answer 5

1. 8 week trial on PPI
   - If symptoms do not improve or if red flags, then further investigations.

Other investigations

• OGD= oesophagitis, Barrett’s, bolus.
• Manometry= achalasia, motor disorder
• Ambulatory pH monitoring= <4, 4% of the time.
• Barium swallow= if signs of dysphagia

Question 6

Differentials for GORD

Answer 6

RULE OUT ACS

Stable agina

Achalasia

Oesophageal carcinoma

Peptic ulcer

Functional dyspepsia/ heartburn

Question 7

Treatment for GORD

Answer 7

1. PPI
   - Omeprazole
   - Esomeprazole
   - Rabeprazole
   - Lansoprazole
2. H2 antagonist adjunct?
   - Rinitidine
   - Cimetidine
3. Surgery if PPI tolerated, but not adherent

Question 8

Barrett’s oesophagus

- Definition

Answer 8

Metaplastic change in the oesophagus due to prolonged exposure to acid
- Tissue change from stratified squamous epithelial to simple columnar epithelium.

Question 9

Barrett’s oesophagus

- Treatment

Answer 9

PPI

Radiofrequency ablation

Surgery: fundoplication, oesophagectomy

Question 10

Medication classes associated with dyspepsia (6)

Answer 10

• NSAIDs
• Bisphosphonates
• Steroids
• Nitrates
• Theophyllines
• Calcium antagonists

Question 11

Barrett’s oesophagus risk factors

Answer 11

Male

Long-term GORD

Previous oesophagitis

Previous haitus hernia

Previous oesophageal strictures/ ulcers