GORD & PUD
Dyspepsia
Non-specific group of symptoms related to the upper GI tract
Alarm symptoms;
 GI bleed
 Weight loss
 Dysphagia
 Iron deficiency anaemia
 Persistent vomiting
 Epigastric mass
 (Suspicious barium meal)
**if any of the above refer for urgent (2ww) endoscopy for patients of ANY age
GORD
Risk factors;
 Hiatus hernia
 Pregnancy/obesity
 Large meals
 Smoking, alcohol
 Drugs; calcium channel blockers, anticholinergics, nitrates
Symptoms;
 ‘heartburn’; retrosternal, burning, related to meals, worse lying down/straining, relieved by
antacids
 Epigastric or Chest pain
 Acid brash & waterbrash
 Odynophagia, dysphagia
 Extra-oesophageal;Nocturnal asthma, Chronic cough, Laryngitis
Investigations;
• ECG; if retrosternal/chest pain
• Bloods
• OGD; mucosal break or normal (ENRD)
• 24 hour oophagia pH monitoring +/- manometry
Treatment;
• Life style changes; weight loss, stop smoking, raise head of bed, small regular meals
• Drugs; Antacids, PPIs, H2 antagonists, prokinetic
• Surgical; Nissen fundoplication
Complications;
• Oesophagitis
• Benign stricture
• Barrett’s oesophagus; premalignant condition when normal oesophageal squamous
epithelium is replaced by gastric columnar epithelium (metaplasia).
Peptic ulcer disease
Incidence ratio
Cause
Pain
Relieving factors
Complications
Gastric Ulcer
1
70% H/pylori, 30% other
Worse on eating
Duodenal ulcer
4
90% H.pylori, 10% other
Worse before meals/at night
eating
More likely to perforate
Risk factors;
• H. Pylori
• NSAIDs (block PGs that stimulate mucus + HCO)
• Alcohol
• Severe stress
• Smoking
• Steroids
• Zollinger-Ellison syndrome; gastrin secreting adenoma
H. pylori;
• Gram negative urease secreting bacteria; converts human urea to ammonia to neutralise the
acid around itself.
• Ammonia raises pH locally, around the pH ‘sensors’; reduces somatostatin release (usually
inhibits gastrin + histamine realise)….leading to excess acid production
• Can lead to chronic gastritis + gastric carcinoma
Symptoms;
 Asymptomatic
 Epigastric pain
- DU; worse when hungry & night
- GU; worse when eating
 Nausea
 Weight loss (GU)
Investigations;
 Bloods
 ECG
 CXR, AXR
 Stool test; H. Pylori antigen
 Urea breath test; swallow urea labelled with C13, measure CO2.
 Serological IgG for H. Pylori (not for eradication)
 OGD; biopsy + urease test
Management
 Lifestyle changes
 Acid reduction
 Eradication therapy - Test + treat; if H. Pylori +ve, triple therapy;PPI + Clarithromycin +
Amoxicillin/Metronidazole
Complications
 Perforation, bleeding, gastric outflow obstruction, malignancy