Give 3 common gastric disorders
- Gastro-oesophageal reflux disease (GORD)
- Peptic ulcer disease (PUD)
Helicobacter pylori infection
What are the anti-reflux mechanisms to prevent reflux of gastric acid into the lower oesophagus?
- Lower oesophagus sphincter
- Oesophagus enters stomach in abdominal cavity
- Pressure in abdominal cavity is higher than that of thoracic
- Right crus of diaphragm acts as slight around the lower oesophagus
What state is the lower oesophagus sphincter usually in?
What happens to the lower oesophageal sphincter as part of the physiology of swallowing?
It transiently relaxes
Why does the lower oesophageal sphincter transiently relax?
To allow the bolus to move into the stomach
Label this diagram, indicating the main antireflux mechanisms on the right
- A - Fundus
- B - Cardia
- C - Body
- D - Antrum
- E - Pylorus
- F - Duodenum
- Lower oesophageal sphincter
- Intra-abdominal oesophagus
- Mucosal valve
- Unumpeded gastric emptying
Is acid reflex ever normal?
Yes, some is
How is mild acid reflex normally dealt with?
- Secondary peristaltic waves
- Salivary bicarbonate
When do clinical features of GORD occur?
When antireflux mechanisms fail and there is prolonged contact of gastric juices with the lower oesophageal muscosa
What are the clinical features of GORD?
What is dyspepsia?
What makes dyspepsia from GORD worse?
- Lying down
- Bending over
- Drinking hot drinks
How is a clinical diagnosis of GORD usually made?
Without investigation- based on symptoms alone
When is there a need to investigate GORD?
- When there are alarming symptoms, such as dysphagia
- When hiatus hernia is suspected
What investigation is made when a hiatus hernia is suspected?
What are the two areas of management for GORD?
What lifestyle changes can be made to manage GORD?
- Loose weight
- Stop smoking
- Reduce alcohol consumption
- Reduce consumption of food groups known to aggrevate
What food groups are known to aggrevate GORD?
- Fatty foods
What medications are given to manage GORD?
- Simple antacids
- Raft antacids (alginates)
- H2 antagonists
Give an example of a simple antacid?
How to simple antacids treat GORD?
They neutralise acid
Give an example of a raft antacid
How to raft antacids treat GORD?
They are taken after eating and create a protective raft that sits on top of the stomach contents to prevent reflux
Give an example of a PPI?
How do PPIs treat GORD?
Reduce acid secretion by parietal cells
Give an example of a H2 antagonist?
How do H2 antagonists treat GORD?
They block H2 receptors which reduce acid secretion
What are the potential complications of GORD?
What causes Barrett's oesophagus?
Continual contact of gastric juices with oesophageal mucus leading to metaplasic change
What factors are associated with GORD?