Gastroesophageal reflux disease

Question 1

What is GERD?

Answer 1

Retrograde flow of stomach contents into the oesophagus causes irritation to the epithelial lining

Question 2

What are risk factors of GERD?

Answer 2

(Main cause) Transient lower esophageal sphincter relaxations (tLESRs)
(Risk factors) Lifestyle habits (i.e. smoking, caffeine + alcohol consumption)
Stress
Obesity
Pregnancy
Scleroderma ( chronic disease caused by abnormal growth of connective tissue)
Sliding hiatal hernia

Question 3

What are the clinical features of GERD?

Answer 3

Retrosternal burning pain + worsens when lying down
Pressure sensation on chest 
Regurgitation 
Non-productive / Nocturnal cough  
Halitosis

Question 4

How is GERD diagnosed?

Answer 4

Clinical features
Endoscopy if dysphagia or >55yrs + alarm symptoms or treatment resistant dyspepsia
pH monitoring + manometry can help if endoscopy normal

Question 5

What is the treatment for GERD?

Answer 5

(Lifestyle) Weight loss, smoking + alcohol cessation, small portion meals
(Medical) Antacids (e.g. magnesium trisilicate). alginates (e.g. gaviscon), PPI (lamsoprazole)
(Surgery) Laproscopic Nissen fundoplication (indications such as Barrett’s, strictures, aspiration)

Question 6

What are the differential diagnosis of GERD?

Answer 6

Other forms of oesophagitis (infection, drug induced, eosinophilic)
Angina
Achalasia (failure of the lower esophageal sphincter to relax)