GORD

Question 1

GORD Epidemiology

Answer 1

• Two to three times more common in men
• 25% of adults experience heartburn
• Spectrum of endoscopy negative GORD to oesophageal mucosal damage which can cause ulceration and stricture
• NSAIDS and doxycycline must be taken with adequate water

Question 2

GORD Aetiology

Answer 2

• Increased pressure
• Inadequate cardiac sphincter
• Smoking, alcohol, fat (delays gastric emptying), coffee
• Pregnancy, obesity

Drugs and smoking relax cardiac sphincter
-No relationship between H. pylori and GORD

Question 3

GORD Presentation

Answer 3

• Heartburn
• Retrosternal discomfort
• Water brash
• Odynophagia

Question 4

GORD Ix

Answer 4

• Endoscopy
• FBC to exclude significant anaemia
• If treatment unsuccessful or endoscopy inconclusive; barium swallow, ambulatory pH monitoring, manometry

Question 5

GORD Differentials

Answer 5

Cancer, ulcer, oesophagitis

Question 6

GORD Guidelines for Referral

Answer 6

• Dysphagia at any age
• Dyspepsia at any age with any of: WL, anaemia, vomiting
• Dyspepsia in a patient aged 55 years or more with at least one of: onset of dyspepsia <1 year previously, continuous symptoms since onset
• Dyspepsia combined with any of the following risk factors: FHx UGI cancer, Barrett’s, pernicious anaemia, peptic ulcer surgery >20 years ago, metaplasia, jaundice, upper abdominal mass

Question 7

GORD Management

Answer 7

• Full dose PPI for one month
• If symptoms return, use, step down strategy to lowest dose of PPI that provides relief
• Refer for endoscopy if inadequate response (stop PPI for 2 weeks before endoscopy)
• If endoscopy shows oesophagitis; PPI 1 month
• If resistant can double dose, add H2RA at bedtime, surgery