GORD

Question 1

What is GORD?

Answer 1

Gastro-oesophageal reflux disease (GORD), is an extremely common condition. It is defined as reflux of stomach contents into the oesophagus, which is associated with troublesome symptoms and/or complications.

Question 2

What is the pathophysiology of GORD?

Answer 2

At the gastro-esophageal junction, a physiological sphincter relaxes to allow food to enter the stomach. this is known as the lower esophageal spinchter (LOS). After entry, the sphincter contracts to prevent reflux of stomach contents. If the LOS contracts inappropriately, stomach content will wash back into the oesophagus. In some individuals, reflux of stomach contents causes troublesome heartburn symptoms and can cause damage to the oesophagal lining.

Question 3

What are the complications of GORD? And describe them briefly.

Answer 3

• erosions (erosive esophagitis- inflammation of the esophagus, which can lead to ulcers, bleeding and peptic stricture formation)
• strictures- scarring and narrowing of the esophagus due to repeated damage. can cause dysphagia, may require dilatation or stenting
• Barrett’s esophagus- premalignant condition due to columnar metaplasia of normal squamous esophageal mucusa

Question 4

What are the common risk factors of GORD?

Answer 4

• High BMI
• Smoking
• Genetic association
• Pregnancy
• Hiatus hernia
• NSAIDs, nitrates, calcium channel blockers, caffeine & alcohol

Question 5

What are the symptoms of GORD?

Answer 5

Cardinal symptom is heartburn, that occurs after meals, worse by lying down or bending forward.

• regurgitation
• dyspepsia
• chest pain
• dysphagia
• odynophagia
• cough
• hoarse voice
• N&V

Question 6

What are the red flag symptoms in someone with GORD?

Answer 6

• weight loss
• anemia
• dysphagia
• new onset dyspepsia

Question 7

What are the differential diagnoses for heart burn?

Answer 7

• functional heart burn
• achalasia
• esinophilic esophagitis
• pericarditis
• ischemic heart disease
• peptic ulcer disease
• malignancy

Question 8

What investigations would you do for GORD?

Answer 8

• 24-hr pH monitoring (can be combined with a high resolution manometry to assess motor abnormalities of the esophagus)
• gastroscopy- reserved for patients with red flag symptoms. Can diagnose esophagitis, Barrett’s esophagus or a gastric malignancy.
• Wireless pH capsules testing- insertion of pH capsule at gastro-esophageal junction during gastroscopy.

Question 9

What are the four reflux phenotypes?

Answer 9

1) Erosive oesophagitis: erosions seen at gastroscopy

2) Non-erosive oesophageal reflux: normal gastroscopy, but pathological acid exposure on pH testing

3) Acid hypersensitive oesophagus: normal gastroscopy, non-pathological acid exposure on pH testing but temporal association of reflux events with symptoms

4) Functional heartburn: normal gastroscopy, non-pathological acid exposure on pH testing and no temporal association of reflux events with symptoms.

Question 10

What is the management for GORD?

Answer 10

• PPIs (for 1 month)
• lifestyle changes- weight loss, smoking cessation, dietary modifications
• surgical- nissen fundoplication