GORD

Question 1

What is GORD?

Answer 1

Reflux of stomach acid back through the LOS, iritating the oesophageal lining.

Question 2

Why is the oesophagus affected by the acid and not the stomach?

Answer 2

Oesophagus has a squamous epithelial lining.

Stomach has columnar epithelial lining and bicarbonate-rich mucus.

Question 3

What causes the reflux to occur?

Answer 3

Transient relaxation of the LOS

Question 4

How does GORD present?

Answer 4

Burning retrosternal chest pain:

• Worse when flat
• Worse with certain foods
• Hoarse voice
• Acid brash (acid in throat, salivate more- water brash)
• Cough

Question 5

When should you do an OGD in GORD?

Answer 5

Concerning Features/Red Flags

• Dysphagia
• Age 55+
• Weight Loss
• Bleeds

Question 6

When should you admit urgently?

Answer 6

Bleeds:

• Melaena
• Coffee ground
• Low Hb

Question 7

How is GORD conservatively managed?

Answer 7

• Reduce caffeine and citrus
• Smaller, lighter meals
• Don’t eat before bed
• Weight loss

Question 8

What OTC medication should be tried first?

Answer 8

• Gaviscon

- Rennie

Question 9

How do Gaviscon and Rennie work?

Answer 9

Antacids

Question 10

What drug should be prescribed first hand?

Answer 10

PPIs

Question 11

What else may be prescribed for GORD?

Answer 11

Ranitidine

Question 12

How does Ranitidine work?

Answer 12

H2 antagonist

- Blocks parietal cell stimulation

Question 13

What surgery is used for GORD?

Answer 13

Fundoplication

Question 14

How does fundoplication work?

Answer 14

Narrows the LOS

Question 15

What can predispose to GORD and gastritis?

Answer 15

H.pylori

Question 16

What is H.pylori

Answer 16

Gram negative helical bacteria

Question 17

Is H.pylori aerobic or anaerobic?

Answer 17

Aerobic

Question 18

How does H.pylori avoid the gastric acid?

Answer 18

Sits in the gastric mucosa

Question 19

How does H.pylori cause epithelial damage?

Answer 19

Breaks the gastric mucosa, exposing the epithelial lining underneath to the acid

Question 20

What does H.pylori produce?

Answer 20

Ammonia (neutralises HCl)

Question 21

Who gets a H.pylori test?

Answer 21

Anyone with dyspepsia

Question 22

What are the H.pylori tests?

Answer 22

• Urea breath test using radiolabelled C-13
• Stool antigen test
• Rapid urease test (on endoscopy)

Question 23

What is the rapid urease test?

Answer 23

CLO Test

• Biopsy on endoscopy
• Add urea to the sample
• H.pylori will use urease to turn the urea to ammonia
• Sample turns alkaline

Question 24

How is H.pylori treated?

Answer 24

Triple eradication

Question 25

What is triple eradication?

Answer 25

- Lansoprazole - Clarithromycin - Amoxicillin

Question 26

How does lansoprazole work?

Answer 26

PPI

Question 27

How does clarithromycin work?

Answer 27

Protein synthesis inhibition | Think Clarithromyprotein

Question 28

How does amoxicillin work?

Answer 28

Beta-lactam- inhibits peptidoglycan cell wall

Question 29

What is Barrett's Oesophagus?

Answer 29

Metaplasia | - Squamous to columnar epithelium

Question 30

What happens to the symptoms with Barrett's?

Answer 30

Symptoms tend to improve

Question 31

What is the lifetime risk of malignancy with Barrett's?

Answer 31

5%

Question 32

What cancer can Barrett's cause?

Answer 32

Adenocarcinoma

Question 33

How is Barrett's treated?

Answer 33

PPI

Question 34

What else is useful to prevent adenocarcinoma in Barrett's?

Answer 34

Regular aspirin

Question 35

How might Barrett's be resolved?

Answer 35

Destruction of the epithelium so it can regenerate: - Cryotherapy - Radiotherapy