GORD

Question 1

How common is GORD?

Answer 1

10-20% of the population

Question 2

What are the Sx of GORD?

Answer 2

Water brash 
Heartburn 
Bad breath 
Chest pain 
Vomiting 
Breathing problems 
Poor dentition 
CAN present as laryngitis, chronic cough, asthma, earache

Question 3

What are the potential complications of GORD?

Answer 3

Oesophagitis – inflamm of epithelium -> ulcers @ gastro oesophageal junction
Oesophageal strictures
Barrett’s oesophagus – intestinal metaplasia squamous -> columnar of distal oesoph
Oesophageal adenocarcinoma

Question 4

What are the RF for developing GORD?

Answer 4

obesity, pregnancy, smoking, hiatus hernia

lifestyle factors - obesity, trigger foods, smoking, alcohol, coffee and stress

medications - antihistamines, Ca channel blockers, antidepressants & sleeping meds

Question 5

What is the pathophysiology of GORD?

Answer 5

Failure of lower oesophageal sphincter

“Angle of His” (angle at which oesoph enters stomach) creates a valve that prevents duodenal bile, enzymes & stomach acid from back travel

Question 6

What are the red flags to ask about with GORD?

Answer 6

dysphagia 
anaemia 
blood in stool 
wheeze 
weight loss 
voice changes

Question 7

What are the steps in diagnosing GORD?

Answer 7

Clinical history
Esophagogastroduodenoscopy (EGD)
Oesophageal pH monitoring = most objective
Endoscopy only if not responding to Tx or Red flags

Question 8

What lifestyle advice can be given for GORD?

Answer 8

avoid coffee, alcohol, chocolate, fatty foods, spicy foods

weight loss, elevate the head of the bed, stop smoking

Question 9

What medication can be recommended for initial GORD Tx?

Answer 9

review and stop any medications that may be exacerbating symptoms, if possible or appropriate

offer a full-dose PPI for 4 weeks for proven GORD to aid healing

offer a full-dose PPI for 8 weeks for proven severe oesophagitis to aid healing

Question 10

How should recurrent symptoms be managed?

Answer 10

• consider alternative diagnosis
• check patient’s adherence
• reinforce lifestyle Mx
• prescribe a further 4 weeks of PPI or add H2 receptor antagonist for people with confirmed oesophagitis

Question 11

When should patients be referred to gastro?

Answer 11

• refractory to treatment, persistent or unexplained
• controlled on acid suppression therapy, but the person does not want to continue treatment long term or cannot tolerate treatment
• associated with RFs for Barrett’s oesophagus