Gastroesphageal Disease (GORD)

Question 1

What is GORD?

Answer 1

• Chronic digestive disorder
• Abnormal flow of stomach and gastric contents into oesophagus
• Acid reflux = irritation inflammation of oesophagus = uncomfortable and severe symptoms

Question 2

Aetiology

Answer 2

• Weakened lower oesophageal sphincter (LES)
• LES: ring of muscle at junction of oesophagus and stomach, acts as one way valve, prevents back flow of stomach acid into oesophagus
• Malfunction of LES = back flow of stomach acid into oesophagus = symptoms of GORD

Question 3

Pathophysiology

Answer 3

• Inappropriate relaxation/dysfunction of LES
• Acidic stomach content (gastric acid, partially digest food) = backflows into oesophagus
• Over time reflux = inflammation and damage to sensitive lining of oesophagus = oesophagitis

Question 4

Risk factors

Answer 4

Obesity
- extra body weight
- pressure on abdomen = force stomach contents into oesophagus
Hiatal hernia
- portion of stomach push through diaphragm = reflux likely
Smoking
- tobacco weaken LES
- increase acid production Diet
- fatty meals, large meals, spicy foods
Pregnancy
- hormonal changes, increase abdominal pressure
Meds
- antihistamines, CCBs, nitrates: relax LES

Question 5

Signs/symptoms

Answer 5

• Heartburn
• regurgitation
• dysphagia
  chronic cough (worse at night)
• hoarseness

Question 6

Diagnosis

Answer 6

• Combo of history, examination for symptoms, diagnostic tests
• Endoscopy: inspect oesophagus, check for inflammation/complications
• Barium swallow and x ray

Question 7

Management

Answer 7

• Lifestyle changes
• Meds: antacids, H2 receptor blockers, PPIs (lansoprazole, omeprazole)
• Surgery: meds infective, severe case, fundoplication to strengthen LES