Gastro-oesophageal reflux disease (GORD) and complications

Question 1

What is GORD?

Answer 1

Gastro-Oesophageal Reflux Disease (GORD) is a condition where stomach acid frequently flows back into the oesophagus, causing symptoms like heartburn and acid regurgitation.

Question 2

What are common symptoms of GORD?

Answer 2

Common symptoms include heartburn, acid reflux (bad taste and cough), and dyspepsia (indigestion).

Worse after eating, and when lying down e.g. night time.

May be relieved by antacids.

Other: cough, halitosis, globus sensation

Question 3

What lifestyle changes are recommended for managing GORD? List 4

Answer 3

1. Weight loss if overweight
2. Elevating the head of the bed
3. Healthy dietary habits and avoiding triggering foods and drinks (e.g., caffeine, spicy foods, alcohol, fatty foods). No food 3 hours before bed.
4. Smoking cessation
5. Stress management

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Question 4

What are the first-line treatments for GORD?

Answer 4

First-line treatments include lifestyle modifications and medications i.e. PPIs and OTC medications like antacids and alginates.

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Question 5

PPI regime for GORD.

Answer 5

4-8 weeks full dose.

Question 6

If reflux is persistent despite 4 weeks of PPIs, what are your next steps?

Answer 6

Endoscopy to look for oesophagitis and causes.

Question 7

Management of severe oesophagitis.

Answer 7

Full dose/double dose PPI for 8 weeks and full-dose PPI long-term maintenance.

Question 8

Alternative medication to PPI.

Answer 8

H2R antagonists e.g. ranitidine, famotidine

Question 9

When should a patient with GORD be referred for endoscopy?

Answer 9

Referral for endoscopy is recommended if there are alarm symptoms such as dysphagia (difficulty swallowing), persistent vomiting, gastrointestinal bleeding, or unexplained weight loss.

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Question 10

What is the role of Helicobacter pylori testing in GORD?

Answer 10

Testing for Helicobacter pylori is recommended in patients with uninvestigated dyspepsia. Eradication therapy is advised if the test is positive.

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Question 11

What surgical option is available for GORD?

For refractory cases

Answer 11

Laparoscopic fundoplication is a surgical option considered for patients with severe GORD not responding to medical treatment.

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Question 12

Complications of untreated GORD. List 4.

Answer 12

• Oesophagitis
• Barrett’s oesophagus (columnar changes)
• Oesophageal stricture
• Oesophageal ulcer/cancer (adenocarcinoma)