GORD

Question 1

Define gastro-oesophageal reflux disease (GORD)

Answer 1

Prolonged and recurrent reflux of gastric contents into the oesophagus. Very common.

Question 2

Epidemiology of GORD

Answer 2

1. 2-3x more common in men

2. 25% adults experience it

Question 3

Causes of GORD

Answer 3

1. Lower oesophageal sphincter hypotension
2. Hiatus hernia
3. Obesity
4. Delayed gastric emptying
5. Gastric acid hypersecretion
6. Oesophageal dysmotility

Question 4

RF GORD

Answer 4

1. Smoking
2. Alcohol
3. Pregnancy
4. Drugs
5. Big meals
6. Obesity

Question 5

Signs and symptoms of GORD

Answer 5

Oesophageal:
1. Heartburn - retrosternal burning pain after meals
2. Belching
3. Acid brash - acid regurgitation
4. Water brash - bitter taste
5. Odynophagia (pain swallowing)
Extra-oesophageal
1. Nocturnal asthma
2. Laryngitis
3. Chronic cough
4. Sinusitis

Question 6

Investigations for GORD

Answer 6

1. Endoscopy if dysphagia or >55 with alarm symptoms
2. 24h oesphageal pH monitoring
3. Manometry - assess strength and coordination of oesophagus

Question 7

ALARM symptoms

Answer 7

1. > 55y
2. FHx of upper GI malignancy in first degree relative
3. Unintended weight loss
4. GI bleeding or iron deficiency anaemia
5. Dysphagia
6. Odynophagia
7. Persistent vomiting

Question 8

Management of GORD

Answer 8

Lifestyle:
1. Lose weight
2. Smaller meals
3. Stop smoking
4. Reduce alcohol, hot/fizzy drinks, tomatoes, onions, citrus fruits
Drugs:
1. Antacids (magnesium carbonate)
2. PPIs (lansoprazole), H2 blocker (ranitidine)
3. Avoid drugs affecting motility - NSAIDs
Surgery

Question 9

Complications of GORD

Answer 9

1. Barrett’s oesophagus (stratified squamous to simple columnar) -> cancer
2. Oesophageal stricture formation