Gastro-Oesophageal Reflux Disease (GORD)

A chronic condition where stomach acid frequently flows back into the oesophagus, causing irritation.

Common in Western populations with approximately 10-20% experiencing weekly symptoms.

• 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).

• 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.

• Heartburn – retrosternal burning sensation.
• Regurgitation of acid or food.
• Chest pain.
• Dysphagia (difficulty swallowing).
• Chronic cough, especially at night.
• Hoarseness or sore throat.

• 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.

• 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.

• Most patients respond to PPIs.
• Complications like Barrett’s oesophagus need monitoring due to the increased risk of oesophageal cancer.

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

• GORD is a chronic condition characterised by clinical features such as heartburn, regurgitation of acid or food, chest pain and dysphagia.
• Multiple aetiologies (e.g., obesity, smoking, medications).
• 24-hour oesophageal pH monitoring is gold standard to confirm diagnosis.
• First line treatment is PPIs, along with lifestyle modifications.
• Monitoring of complications, such as Barrett’s oesophagus is crucial due to the increased risk of oesophageal cancer.