GORD

Question 1

What is GORD?

Answer 1

Gastro-oesophageal reflux disease

Disease characterised by Reflux of gastric acid into the oesophagus

Question 2

What causes GORD?

Answer 2

Hiatus Hernia

Displacement of the stomach through the oesophageal hiatus of the diaphragm

2 types: sliding and para-oesophageal

Question 3

Give a brief overview of the pathology/effects of GORD on the oesophagus

Answer 3

• Thickening of squamous epithelium
• Healing by Fibrosis:
• Stricture formation
• Reduced Oesophageal motility
• Oesophageal obstruction
• Oesophageal Ulceration
• Barrett’s oesophagus/metaplasia

Question 4

Describe the presentation of GORD

Answer 4

Heartburn / retrosternal pain or discomfort

Regurgitation of gastric contents - especially when lying flat

Worse with hot drinks/alcohol

Relieved by antacids

Question 5

Describe the investigations for GORD

Answer 5

Endoscopy:

• Identify Hiatus hernia and oesophagitis
• Barrett’s oesophagus (if present)

Oesophageal manometry and pH studies

Question 6

How is GORD managed?

Answer 6

50% of patients managed in primary care (without surgery) - given drugs and advice

• Antacids
• Weight loss
• Sleep more upright

Question 7

How is GORD managed surgically?

Answer 7

In suitable patients (GORD, +ve endoscopy, +ve pH study/manometry) then perform laparoscopic hiatus hernia repair and Fundoplication