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Gastro-Oesophageal Reflux Disease (GORD)

Background Knowledge 🧠

Definition

A chronic condition where stomach acid frequently flows back into the oesophagus,Β 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 πŸŒ‘️

Symptoms

  • Heartburnretrosternal burning sensation.

  • Regurgitation of acid or food.

  • Chest pain.

  • Dysphagia (difficulty swallowing).

  • Chronic cough, especially at night.

  • Hoarseness or sore throat.

Investigations πŸ§ͺ

Diagnostic Tests

  • Endoscopy: To assess for oesophagitisΒ 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 πŸ₯Ό

Management

  • Lifestyle modifications: Weight loss, elevate head when sleeping, avoid trigger foods, smoking cessation.

  • 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.

Complications

  • Oesophagitis
  • Barrett’s oesophagus (precancerous lesion)
  • Oesophageal stricture
  • Oesophageal adenocarcinoma

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Symptom relief in GORD may be achieved by which one of the following?

Lying down worsens symptoms

This exacerbates symptoms at night.


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