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GORD (Risk factors (Obesity, Pregnancy, Drugs Relax sphincter (nitrates,…
GORD
Risk factors
Obesity
Pregnancy
Drugs
Relax sphincter (nitrates, anticholinergics, TCAs, CCBs)
Irritate mucosa (NSAIDs, K+ salts, bisphosphonates)
Smoking
Sphincter surgery
e.g. alkalasia
Alcohol
Pyloric stenosis
Clinical
presentation
Chest pain
Radiation
Nil
Associated symptoms
Belching, regurgitation,
odonophagia, waterbrash
Character
Burning
Timing
Intermittent
Onset
Sudden, insidious
Exacerbating/relieving factors
Exacerbating: large meal, lying down, bending over
Relieving: antacids
Site
Retrosternal
Belching
Regurgitation
Waterbrash
(mouth fills with saliva)
Odonophagia
(pain on swallowing
Secondary cough, laryngitis,
nocturnal asthma, sinusitis
Classification
Los Angeles grades)
Grade 2
Mucosa break >5mm long
limited to space betw 2 mucosal fold tips
Grade 3
Mucosal break continuous between tips of 2+ mucosal folds
but <75% oesophageal circumference involved
Grade 1
1+ mucosal breaks, <5mm,
not ext further than 2 mucosal fold tips
Grade 4
Mucosal break involving >75%
oesophageal circumference
Epidemiology
Common
Young males, older females,
both genders in middle age
Age 25-70y
Pathophysiology
Transient relaxation of lower oesophageal sphincter due
to high stomach pressure or reduced oesophagus tone
Gastric juice reflux into oesophagus, exposing
to low pH, bile, pepsin
Irritation to oesophageal mucosa over time
Diagnosis
(
clinical
)
Examination
Investigations
Ba swallow
If suspected hiatus hernia
24h pH monitoring +/- mannometry
If endoscopy normal
Endoscopy
Only for certain patients (symptoms>4wk,
persistent vomiting, GI bleed/Fe deficiency,
palpable mass, age>55 years, dysphagia,
persisting symptoms despite tx, weight loss)
History
Management
Medical
Antacids
Indication: mild disease
E.g: Gaviscon, ranitidine
MOA: Gaviscon contains alginate,
forming a raft on gastric contents;
ranitidine is a H2-R antagonist
PPIs
Indication: more severe disease
E.g.: omeprazole, lansoprazole
MOA: inhibit proton pump, raise pH
Surgery
Indication: severe intractable symptoms
Methods: laparoscopic fundoplication
MOA: increase resting lower oesophageal
sphincter pressure thus reduce reflux and irritation
Conservative
Meal size and timing
Small meals
Eat >3h before bed
Avoid aggrevators
Alcohol, hot drinks, certain foods
Raise bed head
Smoking cessation
Weight loss
Avoid certain drugs
Affecting motility (nitrates, anticholinergics, CCBs)
Affecting mucosa (NSAIDs, bisphosphonates, K+ salts)
Definition
Gastrointestinal disorder
due to reflux of stomach contents
causes 2+ heartburn episodes/wk
and/or complications