GORD Flashcards
what is the definition of GORD?
symptoms or complications resulting from the reflux of gastric contents into the oesophagus or beyond, into the oral cavity (including larynx) or lung
what is the epidemiology of GORD?
Low incidence in east Asia
Common
10-30% people in developed countries
what is the aetiology of GORD?
The lower oesophageal sphincter regulates food passage from the oesophagus to the stomach and contains both intrinsic smooth muscle and skeletal muscle. Episodes of transient lower oesophageal sphincter relaxation are a normal phenomenon, but they occur more frequently in GORD, causing reflux of gastric contents into the oesophagus. Transient lower oesophageal sphincter relaxation is more common after meals and is stimulated by fat in the duodenum. It is more likely to occur if there is a hiatal sac containing acid. Patients with severe reflux often have a hiatus hernia and decreased resting lower oesophageal sphincter pressure. However, pressure can be high at the lower oesophageal sphincter in some patients with mild to moderate reflux
what are the risk factors for GORD?
Family history Older age Hiatus hernia Obesity LOS tone reducing drugs, psychological stress, asthma, NSAIDs, smoking, alcohol consumption, POEM, dietary factors
what is the pathophysiology of GORD?
The severity of mucosal damage depends on the duration of contact with gastric contents, characteristics of the gastric contents (acid, pepsin, and bile salts are damaging to the mucosa), and resistance of the epithelium to damage.
The duration of contact with gastric contents depends on the number of episodes of reflux, the efficacy of oesophageal peristalsis, and the neutralisation of acid by saliva. Low-amplitude oesophageal contractions can occur in severe reflux, reducing the ability to clear acid from the oesophagus.
what are the key presentations of GORD?
Presence of risk factors
Heartburn
Acid regurgitation
what are the signs of GORD?
Risk factors
Halitosis
what are the symptoms of GORD?
Heartburn Acid regurgitation Dysphagia Bloating Laryngitis Globus Enamel erosion Dyspepsia
what are the first line and gold standard investigations for GORD?
PPI trail - symptom improvement
what are the differential diagnoses of GORD?
ACS
Stable angina
functional oesophageal disorder
how is GORD managed?
Acute:
Standard-dose proton pump inhibitor, lifestyle changed
Chronic:
Continued proton pump, surgery, transoral incisionless fundoplication
Higher dose proton pump inhibitor, H2 antagonist
how is GORD monitored?
Routine endoscopy to assess disease progression in subjects with erosive or non-erosive GORD is not recommended.
what are the complications of GORD?
Oesophageal ulcer, haemorrhage or perforation
Oesophageal stricture
Barrett’s oesophagus
what is the prognosis of GORD?
Most patients respond to treatment with proton-pump inhibitors (PPIs). Maintenance PPI therapy is recommended for those who have symptoms when the PPI is discontinued, as well as for those with erosive oesophagitis and Barrett’s oesophagus.
