Gastro-Oesophageal Reflux Disease (GORD)

Question 1

what is GORD?

Answer 1

a condition whereby gastric contents from the stomach leaks up into the oesophagus

Question 2

what type of epithelial lining does the oesophagus and stomach have?

Answer 2

• the oesophagus has a squamous epithelial lining, making it more sensitive to stomach acid
• the stomach has a columnar epithelial lining, which provides more protection against stomach acid

Question 3

what is the aetiology of GORD?

Answer 3

• greasy/spicy food
• coffee + tea
• alcohol
• NSAIDs
• stress
• smoking
• obesity
• hiatus hernia

Question 4

what is the function of the lower oesophageal sphincter + how does it relate to GORD?

Answer 4

• the lower oesophageal sphincter controls the passage of contents from the oesophagus to the stomach
• in GORD, episodic sphincter relaxations become more frequent, allowing reflux of gastric contents into the oesophagus

Question 5

how do hiatus hernias contribute to reflux?

Answer 5

a hiatus hernia disrupts the oesophageal sphincter, increasing reflux episodes

Question 6

what are the risk factors for GORD?

Answer 6

• obesity
• smoking
• alcohol
• pregnancy
• male

Question 7

what is the defining symptom of GORD?

Answer 7

• a burning retrosternal sensation, worse after meals, lying down or bending over, or straining
• can be relieved (at least partially) by antacids

Question 8

what are the additional symptoms of GORD?

Answer 8

• heartburn
• acid regurgitation
• retrosternal/epigastric pain
• bloating
• nocturnal cough
• hoarseness

Question 9

what are the investigations for GORD?

Answer 9

• 24-hour pH monitoring
• OGD

Question 10

what are the red-flag symptoms for a patient with GORD?

Answer 10

• dysphagia
• age >55 with weight loss + upper abdominal pain, dyspepsia, or reflux

Question 11

what is the conservative management of GORD?

Answer 11

• avoidance of precipitants
• weight loss
• smoking cessation

Question 12

what is the medical management of GORD?

Answer 12

• cessation of NSAIDs
• PPI
• antacid (e.g. gaviscon)

Question 13

what is the main surgical intervention for GORD + how does it work?

Answer 13

• fundoplication
• this involves dissecting the gastro-oesophageal junction + hiatus, wrapping the fundus around the GOJ to recreate a physiological lower oesophageal sphincter + narrowing the hiatal opening in the diaphragm

Question 14

what are the long-term complications of GORD?

Answer 14

• aspiration pneumonia
• barrett’s oesophagus
• oesophageal stricture
• oesophageal cancer