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Which of these statements about GORD are true?
Most patients complain of nausea
GORD may be due to alkaline reflux
Mild GORD may affect up to 40 per cent of adults
Patients with GORD do not complain of pain associated with stooping
Regarding the pathophysiology of GORD, which of these statements are true?
Reflux of gastric contents into the oesophagus is a normal physiological event
22 per cent of adults with reflux symptoms have evidence of oesophagitis on endoscopy
Symptoms of GORD correlate poorly with the presence of hiatus hernia
Patients with severe reflux disease have more but shorter episodes in which oesophageal luminal pH is <4.0
Which of these classes of drugs are typically associated with GORD?
statins
NSAIDs
bisphosphonates
corticosteroids
Which of these factors increases the likelihood of GORD or exacerbates symptoms?
Smoking
Pregnancy
Stress
Weight loss
The Savary-Miller classification is the scale most frequently used to grade reflux oesophagitis. Which of these statements are true?
Grade 1 lesions are defined as clusters of small (<0.5cm) superficial ulcers
Grade 2 lesions are non-erosive lesions affecting a single longitudinal fold
Grade 3 lesions are circumferential
Grade 4 lesions are chronic and include strictures
Which of these statements about the investigation of GORD are true?
Typical reflux symptoms are 90 per cent specific for GORD and, when predominant, allow a confident clinical diagnosis
Eradication of
Helicobacter pylori
is recommended as initial treatment
A barium swallow does not detect stricture
Gastroscopy is the investigation of choice
Which of these statements about the complications of GORD are true?
The overall risk of adenocarcinoma in a patient with Barrett's oesophagus is small
Oesophageal ulcer is a rare complication of severe reflux
All patients with Barrett's oesophagus must be enrolled into a screening programme
About 10 per cent of patients develop benign peptic strictures
Which of these statements about the management of GORD are true?
Most patients will be symptom-free after appropriate lifestyle change
Pillows should not be used because they may worsen GORD
People with GORD should avoid protein-rich foods
People with GORD should be encouraged to drink fruit juice in preference to tea or coffee
Regarding drugs for the treatment of GORD, which of these statements are true?
The duration of acid suppression by H
2
-antagonists averages 12 hours
One dose of omeprazole reduces acid suppression for 2 - 3 days
The prokinetic agent metoclopramide relieves reflux symptoms less effectively than an H
2
antagonist
A prokinetic agent plus sucralfate is a suitable treatment for alkaline reflux
Which of these statements about the drug treatment of GORD are true?
PPIs achieve healing rates for grades 2-4 oesophagitis that are approximately twice as great as those seen with H
2
antagonists
After 12 months' maintenance therapy, approximately 80 per cent of patients taking full-dose omeprazole will be in remission
Low-dose PPIs are no more effective than ranitidine as long-term maintenance therapy
12-month healing rates in patients with recurrent oesophagitis are almost as high for low-dose (15mg/day) as for full-dose (30mg/day) lansoprazole
Which of these statements about the drug treatment of GORD are true?
Over the first year after healing, almost three-quarters of patients do not relapse, or relapse once and need intermittent treatment
Patients who need a PPI should have intermittent treatment after healing
Patients newly diagnosed with severe GORD should step-up treatment, beginning with lifestyle change, antacids and an H
2
antagonist before considering a PPI
Some patients need double-dose PPI therapy to achieve healing but, of these, 70 per cent can subsequently be stepped down
Which of these statements about the management of GORD are true?
Lansoprazole is the most effective PPI for healing GORD
NICE recommends that if symptoms recur after healing a PPI should be offered at full dose to control symptoms quickly
Fundoplication may be curative
Patients most likely to benefit from surgery include those with large volume reflux
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