GORD

Question 1

Define

Answer 1

• Inflammation of the oesophagus caused by reflux of gastric acid and/or bile.

Question 2

Aetiology/risk factors

Answer 2

Disruption of the following:
o	Lower oesophageal sphincter 
o	Acute angle of junction 
o	Mucosal rosette 
o	Intra-abdominal portion of oesophagus (diaphragm acts as a sphincter) e.g. obesity, pregnancy

+ fatty meals make it worse

Question 3

epidemiology

Answer 3

common in 5-10% of adults

Question 4

symptoms

Answer 4

sharp severe epigastric pain which is made worse by:
lying supine
bending 
fatty meals
alcohol 
large meals

made better with antacids

Waterbrash - bad taste in the mouth due to hypersalivation

Question 5

signs

Answer 5

epigastric tenderness

wheeze on chest auscultation

dysphonia

Question 6

investigations

Answer 6

clinical diagnosis

Give PPI and should get better

upper GI endoscopy and biopsy (confirms presence of oesophagitis and can exclude malignancy – must exclude for all >55 years)
• Other tests: 24h pH monitoring, manometry, barium swallow

Question 7

management

Answer 7

o	Weight loss 
o	Elevating head of bed 
o	Avoid provoking factors 
o	Stop smoking 
o	Lower fat meals 
o	Avoid large meals late in the evening

Medical:
o	Antacids 
o	Alginates 
o	H2 antagonists (e.g. ranitidine) 
o	Proton pump inhibitors (e.g. lansoprazole, omeprazole) 

Endoscopy:
o Annual endoscopic surveillance - looking for Barrett’s Oesophagus
o May be necessary for stricture dilation or stenting

Surgery:
o Antireflux surgery if refractory to medical treatment
• Nissen Fundoplication:
o Fundus of the stomach is wrapped around the lower oesophagus - helps reduce the risk of hiatus hernia and reduce reflux

Question 8

complications

Answer 8

• Oesophageal ulceration
• Peptic stricture
• Anaemia
• Barrett’s oesophagus
• Oesophageal adenocarcinoma
• Associated with asthma and chronic laryngitis

Question 9

prognosis

Answer 9

• 50% respond to lifestyle measures alone
• In patients that require drug therapy, withdrawal is often associated with relapse
• 20% of patients undergoing endoscopy for GORD have Barrett’s oesophagus