GORD

Question 1

Definition

Answer 1

A condition Where acid from the stomach leaks up into the oesophagus

Question 2

Aetiology/ causes

Answer 2

Underlying cause of GORD is reflux of gastric acid, pepsin, bile and duodenal contents back into the oesophagus.

The lower oesophageal sphincter (LOS) remains closed and relaxes when swallowing is initiated, transient lower oesophageal sphincter relaxations (TLESRs) are part of normal physiology but occur more frequently in patients with GORD – allowing gastric acid to flow back into the oesophagus.

Question 3

Risk factors

Answer 3

Increased abdominal pressure (pregnancy)
Low LOS pressure
Genetics (possibly)
Obesity
Large meals
Cigarette smoking
Systemic sclerosis
Hiatus hernia

Question 4

Epidemiology/ Population affected

Answer 4

Common with a prevalence of 10-20% in the developed world

More common in the Western world than in Asia

In general, the prevalence of GERD increases with age, with the highest rates observed in individuals over 60 years old. In terms of sex, some studies suggest that women may be slightly more likely to develop GERD than men.

Question 5

Clinical presentation

Answer 5

Burning
Worse on bending, stooping, or lying down.
Seldom radiates to the arms.
Worse with spicy food, hot drinks, or alcohol
Relieved by antacids

Cardiac ischaemic pain
Gripping or crushing
Radiates to neck or left arm
Worse with exercise
Accompanied with dyspnoea.
Heartburn, coughing, hoarse voice, postnasal drip, asthma are frequently seen but not common.

Question 6

Prognosis

Answer 6

Approximately half of patients with reflux symptoms in primary care can be treated successfully with simple antacids, loss of weight and raising the head of the bed at night.

Precipitating factors should be avoided.

Question 7

DDX

Answer 7

Achalasia
Acute gastritis
Antral web cholelithiasis
Chronic gastritis
Oesophageal cancer
Coronary artery atherosclerosis