Pathophysiology of Gastroesophageal Reflux Disease
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Pathophysiology of Gastroesophageal Reflux Disease

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Questions and Answers

What characterizes erosive oesophagitis in the context of Gastro-oesophageal Reflux Disease?

  • Presence of gastrointestinal bleeding
  • Endoscopically visible breaks in the distal oesophageal mucosa (correct)
  • Asymptomatic reflux episodes
  • Presence of peptic ulcers in the stomach

    • Which of the following factors is NOT associated with an increased risk of developing Gastro-oesophageal Reflux Disease?

  • Age over 50 years
  • Obesity
  • Smoking habits
  • Regular physical exercise (correct)

    • Which treatment option is commonly used for relief from symptoms of Gastro-oesophageal Reflux Disease?

  • Proton Pump Inhibitors (PPIs) (correct)
  • H2 receptor antagonists
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Antibiotics

    • How is Nonerosive Reflux Disease identified during endoscopy?

    <p>Troublesome symptoms without visible mucosal injury</p> Signup and view all the answers

    Which symptom is associated with pathologic reflux in Gastro-oesophageal Reflux Disease?

    <p>Occasional nocturnal symptoms</p> Signup and view all the answers

    Which symptom is NOT typically associated with gastroesophageal reflux disease (GORD)?

    <p>Photosensitivity</p> Signup and view all the answers

    What is the first-line treatment for gastroesophageal reflux disease (GORD)?

    <p>Proton pump inhibitors (PPI)</p> Signup and view all the answers

    Which of the following conditions is commonly associated with GORD?

    <p>Chronic cough</p> Signup and view all the answers

    What does pH impedance monitoring help to assess in patients with GORD?

    <p>Proximal reflux in absence of typical symptoms</p> Signup and view all the answers

    Which factor is NOT considered an alarm symptom for GORD?

    <p>Heartburn after every meal</p> Signup and view all the answers

    How does obesity contribute to the risk of developing GORD?

    <p>Increases strain on the antireflux barrier</p> Signup and view all the answers

    What is the specificity range for the sensitivity of erosive esophagitis based on classical symptoms?

    <p>30-76%</p> Signup and view all the answers

    Which of the following is NOT a typical symptom of GORD?

    <p>Chronic fatigue</p> Signup and view all the answers

    In terms of diagnosis, what role does endoscopy play for patients with GORD?

    <p>Identifies alarm symptoms</p> Signup and view all the answers

    Which common extraesophageal symptom is frequently linked to GORD?

    <p>Laryngitis</p> Signup and view all the answers

    Which of the following mechanisms mainly stimulates transient lower esophageal sphincter relaxations (tLESRs)?

    <p>Distension of the proximal stomach</p> Signup and view all the answers

    What contributes to the protective factors against gastroesophageal reflux disease (GORD)?

    <p>Oesophageal clearance mechanisms</p> Signup and view all the answers

    In the context of reflux diseases, what characterizes reflux hypersensitivity?

    <p>Normal acid exposure with symptom correlation</p> Signup and view all the answers

    Which of the following is NOT a mechanism that can lead to low lower esophageal sphincter (LES) pressure?

    <p>Mild fluid intake</p> Signup and view all the answers

    Which condition is associated with prolonged reflux exposure during sleep?

    <p>Hiatus hernia</p> Signup and view all the answers

    Which diagnostic method is specifically utilized to assess the correlation between symptoms and acid reflux events?

    <p>Oesophageal acid perfusion study</p> Signup and view all the answers

    What is a characteristic feature of non-erosive reflux disease?

    <p>Increased acid exposure without erosions</p> Signup and view all the answers

    What is a likely result of aging in relation to oesophageal mucosal integrity?

    <p>Decreased Na+/H+ exchanger function</p> Signup and view all the answers

    Which of the following is a symptom commonly associated with gastroesophageal reflux disease?

    <p>Chest pain</p> Signup and view all the answers

    What role does swallowed saliva play in protecting against acid reflux?

    <p>Provides buffering through bicarbonate</p> Signup and view all the answers

    Study Notes

    Pathophysiology

    • Pathological Gastroesophageal Reflux Disease (GORD) occurs when there’s increased esophageal exposure to gastric juice.
    • Other factors include a reduced threshold for epithelial injury and increased symptom perception (visceral hypersensitivity).

    Anti-reflux Barrier

    • The anti-reflux barrier is formed by the lower esophageal sphincter (LOS), the crural diaphragm, and the supporting structures of the gastro-esophageal flap valve.

    Mechanisms of Reflux

    • Transient LES relaxations (TLESRs) occur independently of swallowing and are not accompanied by peristalsis.
    • TLESRs are accompanied by diaphragmatic inhibition and persist for longer periods than swallow-induced LES relaxations (>10 seconds).
    • The dominant stimulus for TLESRs is distension of the proximal stomach.
    • TLESRs typically account for up to 90% of reflux events in normal subjects or GERD patients without a hiatus hernia.

    Low LES Pressure

    • Low LES pressure, swallow-associated LES relaxations, and straining during periods with low LES pressure can lead to reflux.
    • These mechanisms are important when synergy between the crural diaphragm and LES is lost.
    • This can occur in cases of hiatus hernia, advanced scleroderma (very low LES pressure), and after surgical myotomy.

    Protective Factors

    • Oesophageal Clearance:
      • Peristalsis plays a role in clearing refluxed contents, but hiatus hernia can impair clearance by causing re-reflux.
      • Gravity also helps clear refluxed contents.
      • Saliva buffers acid and promotes mucosal repair and defenses.
      • Prolonged reflux exposure time can occur during sleep and in smokers.
    • Oesophageal Mucosal Integrity:
      • Tight junctions protect the esophageal mucosa.
      • The Na+/H+ exchanger; and a sodium dependent Cl-/HCO3- exchanger help maintain mucosal integrity.
      • Mucosal integrity decreases with age and poor nutritional status.

    Oesophageal Hypersensitivity

    • Different phenotypes of reflux can occur despite similar symptoms:
      • Non-erosive reflux disease: Increased acid exposure without erosions/ulceration.
      • Reflux hypersensitivity: Normal acid exposure with correlation between symptoms and acid reflux events.
      • Functional heartburn: Normal acid exposure with no correlation between symptoms and reflux events.

    Obesity

    • Increased intragastric pressure in obese individuals puts more strain on the anti-reflux barrier.
    • Even small amounts of weight loss can reduce symptoms.
    • Obesity is linked to increased risk of hiatus hernia.

    Clinical Features

    • Typical Symptoms: Heartburn, regurgitation, epigastric pain, early satiety, belching, and bloating.
    • More Common After Meals/At Night: Symptoms are often more frequent after meals and at night.
    • Relief With Antacids: Symptoms can be relieved with antacids.
    • Other Symptoms: Dysphagia, stricture, odynophagia, esophageal ulcer, globus sensation, and chest pain.
    • Chest Pain: Chest pain associated with GORD must be carefully evaluated to exclude cardiac causes.

    Extraoesophageal Symptoms

    • GORD can be associated with chronic cough, laryngitis, asthma, and dental caries.
    • GORD is considered a co-factor, rather than the main causative factor, in these conditions.
    • It is important to investigate for other causes of extraoesophageal symptoms.
    • Pharyngeal pH monitoring can help identify proximal reflux in these cases.
    • A trial of PPI remains the first-line treatment for extraoesophageal symptoms.

    Diagnosis

    • Clinical:
      • Classical symptoms include heartburn and regurgitation.
      • Sensitivity for Erosive oesophagitis is only 30-76%, specificity 62-96%.
      • An empirical PPI trial is often used - PPI response has sensitivity of 62-96%, specificity 30-76%.
    • Endoscopy:
      • Endoscopy is indicated for patients with alarm symptoms (those at increased risk for Barrett's oesophagus, long duration of GORD symptoms, age >50, obesity, especially Gastro-oesophageal Reflux Disease), or those with suspected Peptic Ulcer Disease.

    Definition

    • Gastro-oesophageal reflux disease (GORD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications.

    Prevalence

    • GORD is a common problem affecting 10-20% of the population in Western countries, but less common in East Asia.
    • Prevalence of GORD is increasing.
    • Risk factors include age greater than 50 years, smoking, NSAID use, and obesity.

    Case Study

    • 50-year-old male with reflux symptoms for 2 years.
    • Occasional nocturnal symptoms.
    • Relief with PPI.
    • Weight gain of 10kg.
    • Smokes 5-10 cigarettes/day.
    • Normal bowel habits.
    • PMHx: IHD, Hypertension, T2DM, OA.
    • Meds: aspirin, irbesartan, naproxen PRN.

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    GORD (Gastro-oesophageal Reflux Disease) PDF

    Description

    Explore the mechanisms and factors contributing to Gastroesophageal Reflux Disease (GORD) in this quiz. Understand the role of the lower esophageal sphincter, the anti-reflux barrier, and transient LES relaxations. Test your knowledge on how these elements interact in the pathology of GORD.

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