Gastro-oesophageal Reflux Disease

Question 1

Define GORD

Answer 1

Symptoms or complications caused by the reflux of gastric contents into the oesophagus, oral
cavity or lung

Question 2

What are the causes/risk factors of GORD?

Answer 2

Causes
• Reduced LOS tone
• Reduced oesophageal acid clearance
• Delayed gastric emptying

Risk factors
• Family history of GORD
• Age
• Obesity
• Pregnancy
• Hiatus hernia
• Systemic sclerosis
• Drugs e.g. nitrates, tricyclics

Question 3

What are the symptoms of GORD?

Answer 3

• Heartburn (worse on lying down, bending over, after drinking)
• Regurgitation (acid brash)
• Cough (vagal stimulation and aspiration)
• Dysphagia (peptic stricture)

Question 4

What are the signs of GORD?

Answer 4

• Wheeze, epigastric tenderness, dysphonia(aspiration)

Question 5

What investigations are carried out for GORD?

Answer 5

• Usually a clinical diagnosis

Investigations are done to:

• Confirm oesophagitis
• Exclude malignancy or metaplasia/dysplasia

• OGD and Biopsy - to confirm oesophagitis
- To detect malignancy or metaplasia/dysplasia.
- done in patients over 55 years; also done in patients presenting with red flags.
• Barium Swallow - to detect hiatus hernia, external compression of the oesophagus and strictures, excluding other causes of dysphagia.
• 24 hr pH monitoring - pH probe placed in lower oesophagus determines the temporal relationship between symptoms and oesophageal pH
• Manometry - diagnose GORD if OGD is normal.
• PPI Trial - GORD confirmed if symptomatic relief

Question 6

What is the management for GORD?

Answer 6

Conservative: 
• Weight loss
• smoking cessation
• alcohol in moderation
• small meals
• reduced spicy food, caffeine, chocolate
•Avoid eating up to 3 hours before bed
•Raise the bed head 

Medical: 
• Antacids e.g. Magnesium trisilicate
• Alginates: Gaviscon 
• H2 antagonists: Ranitidine 
• PPI e.g. Lansoprazole 
• Avoid NSAIDs, Bisphosphonates, CCB, anticholinergics and nitrates 

Surgical: Considered if the GORD is severe, as indicated by pH monitoring or if medical treatment fails to treat symptoms.
• Nissen fundoplication (fundus of the stomach is wrapped around the lower oesophagus and held with seromuscular sutures) helps reduce any hiatus hernia and reduce reflux.
• Laparoscopic insertion of magnetic bead bands.
• Radiofrequency-induced hypertrophy.

Monitor Complications:
Annual OGD to monitor for Barrett’s oesophagus.

Question 7

What are the complications of GORD?

Answer 7

• Oesophagitis
• Barrett’s Oesophagus
• Adenocarcinoma
• Oesophageal Carcinoma
• Oesophageal Stricture
• Malnutrition