GORD

Definition

Gastro oesophageal reflux disease (GORD) is a common chronic condition where stomach contents including acid produced by the stomach leak into the oesophagus.

Etiology
  • Common causes:
    • Increased relaxation of lower oesophagus sphincter
    • Imbalance between intragastric and lower oesophageal sphincter pressure
    • Impaired oesophageal acid clearance
    • Hiatus hernia
  • Risk factors:
    • Smoking
    • Caffeine
    • Alcohol
    • Psychological stress
    • Obesity
    • Pregnancy
    • Gastrectomy
Clinical Features
  • Typical symptoms
    • Retrosternal burning pain (Heartburn)
    • Regurgitation
    • Dysphagia
  • Atypical symptoms
    • Pressure sensation in the chest/noncardiac chest pain
    • Belching, bloating
    • Dyspepsia, epigastric pain
    • Nausea
    • Halitosis
  • Extraoesophageal symptoms
    • Chronic nonproductive cough and nighttime cough
    • Hoarseness
    • Dental erosions
  • Aggravating factors
    • Lying down shortly after meals
    • Certain foods/drinks
Investigations
  • Atypical symptoms: consider an endoscopic evaluation if alarm features present:
    • Dysphagia
    • Odynophagia
    • Early satiety
    • Anaemia or evidence of GI bleeding
    • Persisting vomiting
    • Unintentional weight loss
    • Aspiration pneumonia
    • No improvement after PPI
  • Oesophageal pH monitoring indicated if the following is present:
    • Refractory GORD symptoms despite PPI therapy
    • Evaluation before surgical or endoscopic antireflux procedure
    • Consider other diagnoses such as peptic ulcer disease, CVD
Management
  • Lifestyle changes
    • Dietary:
      • Small portions, avoid eating 3 hours before bedtime, avoid triggering food and drinks
    • Physical:
      • Weight loss if obese, elevate head of the bed
    • Reduce triggers
      • Smoking, alcohol, caffeine, medication (eg. CCBs, diazepam)
  • Pharmacological Therapy
    • PPIs for 8 weeks:
      • Continue if good response
      • Increase dose if partial response
      • Stop if no response
    • H2 receptor antagonist:
      • Alternative GORD treatment
      • Combined therapy with PPI for nighttime symptoms
  • Surgical Therapy
    • If the previous two failed
    • Fundoplication (creating artificial sphincter with gastric fundus)

 

 

 

 

 

 

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