17th July 2023

Gastro-Oesophageal Reflux Disease (GORD)

GORD is a common condition, which can be defined as the reflux of gastric acid into the oesophagus, causing mucosal injury (erosive oesophagitis) or symptoms. Mild cases may be diagnosed clinically and managed in primary care without the need for further investigation. However, the gold standard diagnostic test is ambulatory 24-hour pH monitoring ― this will help differentiate GORD from functional dyspepsia. Endoscopy may be required if patients have ALARM symptoms or have refractory disease.

Management

• Lifestyle measures ― weight management, smoking cessation, modify caffeine, alcohol, and spicy foods
• Medication review (common culprit medications – bisphosphonates, NSAIDs, steroids, calcium channel blockers)
• Medical management ― H2 antagonists, proton-pump inhibitors, antacids, surface agents (sucralfate)
• Invasive procedures ― endoscopic v surgical (Nissen’s fundoplication)

Complications

GORD can result in a number of oesophageal and extra-oesophageal complications.

Oesophageal:

• Erosive oesophagitis
• Barrett’s oesophagus ― normal oesophageal squamous epithelium undergoes metaplasia and becomes columnar epithelium in response to acid exposure. This increases the risk of oesophageal adenocarcinoma. Therefore, patients are risk stratified to determine the frequency of endoscopic surveillance. Some patients may require interventions such as radio-frequency ablation (RFA)
• Oesophageal strictures

Extra-oesophageal:

• Dental issues
• Asthma
• Chronic laryngitis