GORD

• Gastro-intestinal reflux disease (GORD) is a condition characterised by retrosternal, and sometimes epigastric pain, as a result of reflux of the acidic contents of the stomach into the oesophagus.
• Causes of GORD:

  • Hiatus hernia
  • Certain foods - fat, chocolate, caffeine
  • Smoking
  • Obesity
  • Dysfunction of the lower oesophageal sphincter
  • Alcohol
  • Heliobacter Pylori
  • Stress
• GORD investigations:

  • Usually clinical - <65 + no red flag symptoms
  • H. pylori testing - urea breath test (requires 2 weeks off of PPIs)
  • Endoscopy
  • Barium swallow
  • 24 hour luminal pH and manometry
  • Radio labeled technitium
• GORD pathophysiology:

  • The lower oesophageal sphincter is responsible for preventing the backflow of stomach contents into the oesophagus. In patients with GORD, its found to relax more frequently and often when it should not. Foods such as fat, chocolate, alcohol and coffee will also relax the oesophageal sphincter.
  • Hiatus hernia - Diaphragm contractions usually assist in the closure of the oesophagus. In a hiatus hernia, part of the stomach is found above the diaphragm, and hence it is unable to do so.
• GORD clinical features:

  • Chest pain - retrosternal, burning, worse on meals and lying down, relieved by antacids
  • Excess belching and waterbrash sensation
  • Nocturnal or chronic cough
• The Los Angeles classification can be used to grade reflux oesophagitis based on severity from the endoscopic findings of mucosal breaks in the distal oesophagus:

  • Grade A – breaks ≤ 5 mm
  • Grade B – breaks > 5 mm
  • Grade C – breaks extending between the tops of ≥ 2 mucosal folds, but< 75% of circumference
  • Grade D – circumferential breaks (≥75%)
• GORD management:

  • Conservative - avoid triggers (alcohol, coffee, fatty foods), weight loss, smoking cessation
  • Antacids - Magnesium Triciliate, Aluminium Hydroxide
  • Alginate containing anatacids
  • PPIs
  • Dopamine agonists - metocloperamide and domperidone
  • Surgical - Nissen fundoplication
• GORD complications:

  • Barrett's oesophagus
  • Anemia
  • Benign oesophageal strictures
  • Gastric volvulus (rare but dangerous, more specific for hiatus hernia)
  • Oesophageal webs