GORD Flashcards
define GORD?
inflammation of the oesophagus caused by reflux of gastric acid and/or bile.
what are the risk factors of GORD?
• Caused by disruption of mechanisms that prevent reflux
• Mechanisms that prevent reflux:
o Lower oesophageal sphincter
o Acute angle of junction
o Mucosal rosette
o Intra-abdominal portion of oesophagus (diaphragm acts as a sphincter)
what is the epidemiology of GORD?
- COMMON
* 5-10% of adults
what are the presenting symptoms of GORD?
• Heartburn • Aggravated by: o Lying supine o Bending o Large meals o Drinking alcohol • Waterbrash • Aspiration • Dysphagia
what are the signs of GORD?
- Usually NORMAL
* Occasionally - epigastric tenderness, wheeze on chest auscultation, dysphonia
what investigations should be done for GORD?
- Upper GI endoscopy
- 24 hr oesophageal pH monitoring
- Barium Swallow
- CXR
indications for an upper GI endoscopy done?
o age>55, symptoms >4 weeks, dysphagia, relapsing symptoms, relapsing symptoms, weight loss.
what will an upper GI endoscopy exclude?
malignancy
what can a barium swallow detect?
o Hiatus hernia
o Peptic stricture
o Extrinsic compression of the oesophagus
what is gold standard for GORD?
• 24 hr oesophageal pH monitoring
what might a CXR detect?
hiatus hernia
what advice should be given for GORD?
o Weight loss o Elevating head of bed o Avoid provoking factors o Stop smoking o Lower fat meals o Avoid large meals late in the evening
how should endoscopically proven reflux be treated?
o Full dose PPI for 1-2 months
o With positive response lowered dose further on
o If no response then double dose PPI for 1 month
how should endoscopically negative reflux be treated?
o Full dose PPI for 1 month
o If response offer low dose treatment (on as required basis)
o If no response then H2RA or prokinetic for 1 month
what should be offered if medical intervention is not working?
o Anti-reflux surgery
