Gastro-oesophageal reflux

Question 1

Explain the epidemiology of GORD

Answer 1

10-20% of people are predicted to suffer from GORD

Question 2

Explain the pathology of GORD

Answer 2

• Exposure to acid/bile
• Cells adapt via increasing the amount of basal squamous cells – more layers = more protection
• Increase in inflammatory cells

Question 3

What are the risk factors/aetiology of GORD?

Answer 3

• Age (prevalence increases with age)
• Obesity
• Defect/relaxation of the lower oesophageal sphincter – smoking, alcohol, coffee (hot drinks)
• Stress
• Drugs – calcium channel blockers, benzodiazepines, anticholinergics, nitrates, theophylline
• Pregnancy - ↑ progesterone and oestrogen
• Hiatus hernia – increases intra-abdominal pressure
• Delayed gastric emptying – fatty foods

Question 4

What are the signs and symptoms of GORD?

Answer 4

• Heartburn – made worse by bending, stooping or lying down
• Retrosternal discomfort
• Pain on swallowing
• Hoarse voice
• Chronic cough

Question 5

Which conditions does GORD similarly present to?

Answer 5

Cardiac ischemic pain – differentiated by:
•	Gripping/crushing pain
•	Radiated down left arm/jaw
•	Worse with exercise
•	Can be breathless
Oesophagitis
Peptic ulcer

Question 6

What investigations are undertaken if GORD is suspected and why?

Answer 6

•	Normally clinical only
Endoscopy only required if there are red flag signs:
•	Dysphagia 
•	Weight loss
•	Upper abdo pain
•	Hemoptysis 
•	Vomiting
•	Anaemia
•	Melena

Question 7

What are the pharmacological treatments for GORD?

Answer 7

• PPI (omeprazole, lansoprazole)

* H2 receptor antagonist e.g. ranitadine (if PPI not enough take at night)

Question 8

What are the non pharmacological treatments for GORD?

Answer 8

• Dietary changes – avoid chocolate, fatty food, spicy food, alcohol
• Try eating smaller meals 3-4 hours before bed
• Lose weight
• Smoking cessation
• Raise the head of the bed
• Discuss stress/anxiety