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Gastro-Oesophageal Reflux Disease (GORD)

With GORD, there's a reflux of gastric contents back up through a defective lower oesophageal sphincter (LOS), causing inflammation (= Reflux Oesophagitis). Risk factors for it include:

  • Hiatus hernia - weakens LOS

  • Smoking, Alcohol, Coffee - decreases LOS tone

  • Obesity, Pregnancy - increases intra-abdominal pressure

  • Intake of specific foods e.g. citrus foods, spicy foods, fat

“Gastroesophageal reflux disease (GERD)” © Laboratoires Servier (Licensed under CC-BY 3.0) https://creativecommons.org/licenses/by/3.0/


Differentials - Peptic Ulcer Disease, Oesophageal cancer, Oesophageal spasm, Angina


Presentation:

Typical presenting symptom is heartburn, which is worse on eating, lying down or bending over. Other atypical symptoms that patients may present with is:

  • Chronic cough

  • Belching

  • Bloating

  • Acid brash - acid in throat causes increased salivation

  • Odynophagia - painful swallow due to oesophagitis/ulcerations

  • Hoarse voice

  • Tooth erosion


Investigations:

Mainly a clinical diagnosis, but investigations that help include:

  • Trial standard-dose PPI

  • OGD if alarming features or atypical, persistent or relapsing symptoms

  • Oesophageal manometry to assess LOS competence


Management:

Conservative:

  • Weight loss

  • Small, lighter meals

  • Avoid eating late at night (3+ hrs)

  • Sleep on left side

  • Less alcohol and coffee


Medical - PPI (1st line), Antacids, H2 receptor antagonist (Antihistamine) e.g. ranitidine - helps reduce stomach acid


Surgical - Laparoscopic fundoplication

Nissen fundoplication - Dr Gray

Complications:

  • Barrett’s Oesophagus

  • Stricture - Presents as progressive dysphagia

  • Oesophageal ulcer

  • Bleeding - Presents as haematemesis/melaena

  • Oesophageal cancer



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