Gastro-oesophageal Reflux

Question 1

What general mechanism underlies GORD?

Answer 1

Abnormal or incompetent lower oesophageal sphincter (LOS)

Question 2

What risk factors are associated with GORD?

Answer 2

Obesity
Family history of GORD
Older age
Hiatus hernia

Weak:

• Stress
• Alcohol
• Smoking
• Pregnancy
• Diet (fatty, fizzy, spicy)
• Drugs that ↓ tone of lower oesophageal sphincter (smooth muscle relaxants, anticholinergics)

Question 3

How do patients with GORD typically present?

Answer 3

Heartburn
Acid regurgitation

Dysphagia, bloating, laryngitis, globus, enamel erosion, halitosis.

Physical exam typically unremarkable.

Question 4

Which criteria is used for classification of GORD?

Answer 4

Los Angeles (1-4)

Question 5

What differentials should be considered alongside GORD?

Answer 5

Coronary artery disease
Oesophagitis, achalasia
Dyspepsia
Peptic ulcer
Malignancy

Question 6

How would you usually investigate GORD?

Answer 6

Clinical diagnosis alone is typical.

If required, PPI therapy can be trialled for both treatment and diagnosis.

Question 7

How is GORD typically managed?

Answer 7

Lifestyle:

• Weight loss
• Smoking cessation
• Diet modification (avoid caffeine, fizzy, alcohol, spice, fats)
• Raise bed head

Medical:

• Antacids
• PPI (-azole’s)

Question 8

What complications should you be wary of when treating a patient with GORD?

Answer 8

Barrett’s oesophagus (metaplasia of distal epithelium to columnar; high risk of progression to adenocarcinoma)

Oesophagitis
Ulcers
Benign stricture
Anaemia