GORD Flashcards
What is GORD?
Gastro-Oesophageal Reflux Disease
A condition whereby gastric acid from the stomach leaks up into the oesophagus
How common is GORD?
Very common - affects around a quarter of the population in Western countries
Represents approximately 4% of primary care appointments
What is the pathophysiology of GORD?
In GORD, the episodic relaxation of the lower oesophageal sphincter (that is part of it’s normal function) becomes more frequent & allows reflux of gastric contents into the oeophagus.
The refluxed acidic gastric contents / alkaline bile results in pain & mucosal damage.
What is the normal function of the lower oesophageal sphincter?
Controls the passage of contents from the oesophagus to the stomach.
What are the risk factors for GORD?
- Age
- Obesity
- Male gender (2:1)
- Alcohol
- Smoking
- Caffeinated drinks
- Fatty / spicy foods.
What are symptoms of GORD?
- Chest pain
- Burning retrosternal sensation
- Worse after meals, lying down, bending over, or straining
- Relieved (at least partially) by antacids.
- Excessive belching
- Odynophagia
- Chronic cough / nocturnal cough
What red flag symptoms should you always check for when someone presents with symptoms of GORD?
Signs of underlying malignancy:
- Dysphagia
- Weight loss
- Early satiety
- Malaise
- Loss of appetite
What signs are typically found on examination?
Examination is typically unremarkable
What tool can be used to grade reflux oesophagitis based on severity from the endoscopic findings of mucosal breaks in the distal oesophagus?
The Los Angeles Classification of Reflux
What are important differentials to consider for GORD?
- Malignancy (oesophageal or gastric)
- Peptic ulceration
- Oesophageal motility disorders
- Oesophagitis
Also important not to miss key cardiac or biliary disease! Coronary artery disease and biliary colic can commonly mimic episodic reflux disease
What investigations may be useful for a patient presenting with symptoms of GORD?
- Urgent endoscopy
For patients with red flag symptoms for upper GI malignancy & those with new onset / worsening symptoms despite PPI
- To exclude malignancy & look for complications of reflux (oesophagitis, stricturing, or Barrett’s oesophagus)
2. 24hr pH monitoring (Gold standard diagnostic investigation) - For patients in whom medical treatment fails and surgery is being considered.
3. Oesophageal manometry (Always done w/ pH monitoring) - To exclude oesophageal dysmotility (which would cause many surgeons to tailor their operative approach or avoid surgery).
What red-flag symptoms do the NICE guidelines state indicate urgent endoscopy?
NICE guidance states the red-flag symptoms for a suspected upper GI malignancy requiring urgent endoscopy are:
- Patients with dysphagia
- Any patient >55yrs with weight loss and upper abdominal pain, dyspepsia, or reflux
How do pH monitoring studies work?
They assess various criteria (e.g. amount of time acid is present in the oesophagus & the correlation between the presence of acid and the patient’s symptoms)
Produces an algorithmic score called the DeMeester score which can help determine a patient’s symptom / reflux correlation.
What conservative steps should be advised to all patients with GORD?
- Avoiding known precipitants
- Alcohol, coffee, fatty foods
- weight loss
- Smoking cessation.
What is the medical management of GORD?
- Proton pump inhibitors (1st line, alongside lifestyle changes)
Symptoms tend to recur rapidly after ceasing to take PPIs and so many patients are likely to remain on them life-long unless they proceed to surgery
