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Gastro-Oesophageal Reflux Disease (GORD)

Definition
  • GORD: A chronic condition where stomach acid frequently flows back into the tube connecting the mouth and stomach (oesophagus), causing irritation.
Epidemiology
  • Common in Western populations with approximately 10-20% experiencing weekly symptoms.
Pathophysiology
  • Impaired lower oesophageal sphincter (LOS) function allows gastric content reflux into the oesophagus.
  • Factors include transient LOS relaxations, LOS hypotension, and anatomical disruption (e.g., hiatal hernia).
Risk Factors
  • Obesity.
  • Smoking.
  • Alcohol consumption.
  • Certain medications (e.g., calcium channel blockers, anticholinergics).
  • Foods like chocolate, peppermint, fatty foods, coffee, and acidic foods (e.g., citrus, tomatoes).
  • Pregnancy.
  • Hiatus hernia.
Clinical Features
  • Heartburn: Retrosternal burning sensation.
  • Regurgitation of acid or food.
  • Chest pain.
  • Dysphagia (difficulty swallowing).
  • Chronic cough, especially at night.
  • Hoarseness or sore throat.
Complications
  • Oesophagitis.
  • Barrett’s oesophagus: Precancerous lesion.
  • Oesophageal stricture.
  • Oesophageal adenocarcinoma.
Investigations
  • Endoscopy: To assess for oesophagitis or complications of GORD.
  • 24-hour oesophageal pH monitoring: Gold standard to confirm diagnosis.
  • Barium swallow: Less commonly used, can show reflux and oesophageal abnormalities.
  • Manometry: To evaluate LOS function.
Management
  • Lifestyle modifications: Weight loss, elevate head of bed, avoid trigger foods, stop smoking.
  • Antacids: Quick relief of symptoms.
  • Proton pump inhibitors (PPIs): First-line treatment (e.g., omeprazole, lansoprazole).
  • H2 receptor antagonists (e.g., ranitidine) if PPIs are contraindicated or ineffective.
  • Surgical intervention, e.g., fundoplication, in refractory cases or if long-term medication is undesired.
Prognosis
  • Most patients respond to PPIs.
  • Complications like Barrett’s oesophagus need monitoring due to the increased risk of oesophageal cancer.

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