Gastro-Oesophageal Reflux Disease (GORD)

Gastroenterology (12%) Core Clinical Conditions

1A: Able to diagnose and manage

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

GORD, short for Gastro-Oesophageal Reflux Disease, is a chronic digestive disorder characterised by the abnormal flow of stomach acid and gastric contents into the oesophagus. This reflux of acidic contents causes irritation and inflammation of the oesophagus, leading to a range of uncomfortable and sometimes severe symptoms

The primary cause of GORD is a weakened or malfunctioning lower oesophageal sphincter (LES). The LES is a ring of muscle at the junction of the oesophagus and the stomach, which normally acts as a one-way valve to prevent stomach acid from flowing back into the oesophagus. However, a malfunction of the LES causes the stomach acid to flow back into the oesophagus, leading to the symptoms of GORD.

The pathophysiology of GORD primarily involves the inappropriate relaxation or dysfunction of the LES. This allows acidic stomach contents, including gastric acid and partially digested food, to flow back into the oesophagus. Over time, this reflux can lead to inflammation and damage to the sensitive lining of the oesophagus, a condition known as oesophagitis.

• Obesity: Excess body weight can put pressure on the abdomen, forcing stomach contents into the oesophagus.

• Hiatal Hernia: This condition occurs when a portion of the stomach pushes through the diaphragm, making reflux more likely.

• Smoking: Tobacco use can weaken the LES and increase acid production.

• Dietary Factors: Consuming large, fatty meals, or spicy foods can trigger GORD symptoms in some individuals.

• Pregnancy: Hormonal changes and increased abdominal pressure during pregnancy can lead to GORD .

• Certain Medications: Some medications, such as antihistamines, calcium channel blockers, and nitrates, can relax the LES and contribute to GORD.

• Heartburn: A burning sensation or discomfort in the chest, often after eating or lying down.

• Regurgitation: The sensation of stomach contents or acid rising into the throat or mouth.

• Dysphagia: Difficulty swallowing or the feeling of food getting stuck in the throat.

• Chronic Cough: A persistent cough, often worse at night.

• Hoarseness: Changes in the voice or recurrent sore throat.

• Diagnosing GERD typically involves a combination of medical history, symptom evaluation, and diagnostic tests.

• Endoscopy to visually inspect the oesophagus and check for inflammation or complications.

• Barium swallow.

• Lifestyle Modifications: Patients are advised to make dietary changes, such as avoiding trigger foods, eating smaller meals, and not lying down immediately after eating. Weight loss, smoking cessation, and elevating the head of the bed during sleep can also help.

• Medications: Antacids, H2 receptor blockers, and proton pump inhibitors (PPIs) such as lansoprazole or omeprazole.

• Surgery: In severe cases or when medications are ineffective, surgical options like fundoplication may be considered to strengthen the LES.

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