Gastro-oesophageal reflux disease (GORD)

Question 1

What is GORD?

Answer 1

Abnormal acid reflux where acid from the stomach refluxes into the oesophagus subsequently damaging the squamous oesophageal lining, causing discomfort.

Question 2

What are the signs and symptoms of GORD?

Answer 2

Heartburn: pain is worse in certain positions, e.g. lying down/stooping and is worse after heavy meals.
Acid taste in mouth- regurgitation.
Water brash (excess salivation).
Dysphagia.
Nocturnal asthma/ chronic cough.
Laryngitis.

Question 3

What are the causes of GORD?

Answer 3

Genetic inheritance of angle of lower oesophageal sphincter.
Oesophagitis.
Sliding hiatus hernia.
Rolling hiatus hernia.

Question 4

What are the risk factors for GORD?

Answer 4

Smoking
Excessive alcohol
Excessive coffee
Obesity
Pregnancy
Drugs, e.g. calcium channel blockers, anti-muscarinics and tricyclic antidepressants.

Question 5

What investigations should be performed for suspected GORD?

Answer 5

Age dependent.
If patient is <55 years old, proceed to treatment unless they have ALARM symptoms, e.g. unintentional weight loss, dysphagia, haematemesis, melaena and anorexia.
If >55 years old, send patient to endoscopy (diagnostic and allows for biopsy) and start 24h pH monitoring.

Question 6

What is the conservative treatment of GORD?

Answer 6

Education
Weight loss
Raising head of bed at night
Avoidance of precipitating factors, e.g. smoking, large meals.

Question 7

What is the medical treatment of GORD?

Answer 7

Antacids, e.g. aluminium hydroxide.
H2 receptor antagonists, e.g. ranitidine.
Proton pump inhibitors, e.g. omeprazole.

Question 8

What is the surgical treatment of GORD?

Answer 8

Nissen’s fundoplication.

Question 9

What is a complication of GORD?

Answer 9

Barrett’s oesophagus.

Question 10

What is Barrett’s oesophagus?

Answer 10

Metaplasia of the normal squamous epithelium of the lower oesophagus to columnar epithelium. Occurs in patients who suffer with GORD for several years. It is a premalignant lesion.

Question 11

What investigation is performed to confirm Barrett’s oesophagus?

Answer 11

Endoscopy with biopsy in all 4 quadrants.

Question 12

What is the treatment of Barrett’s oesophagus?

Answer 12

HALO system radiofrequency ablation or mucosal resection for highly dysplastic lesions.

Question 13

What is a complication of Barrett’s oesophagus?

Answer 13

Adenocarcinoma of the oesophagus.