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Gastro-oesophageal Reflux Disease (GORD) (Causes (Overeating, Smoking,…
Gastro-oesophageal Reflux Disease (GORD)
Key Facts
Exists when reflux of stomach contents (acid +/- bile) causes troublesome symptoms and/or complications
Reflux of gastric contents is normal but when there is prolonged contact of gastric contents with the mucosa this results in clinical symptoms
GORD is common
When there is prolonged reflux this may cause oesophagi's, stricture or Barrett's oesophagus
Causes
Overeating
Smoking
Slow gastric emptying
Alcohol
Gastric acid hypersecretion
Pregnancy - results in increased abdominal pressure
Abdominal obesity
Fat, chocolate, coffee or alcohol ingestion
Loss of oesophageal peristaltic function
Drugs e.g. anti-muscarinic, calcium channel blockers and nitrates
Systemic sclerosis
Hiatus hernia
Lower oesophageal sphincter hypotension
Pathophysiology
Clinical features of GORD appear when the anti-reflux mechanisms fail, thus allowing acid gastric contents to make prolonged contact with the lower oesophageal mucosa
The LOS relaxes transiently, independently of a swallow, after meals
In GORD there are MUCH MORE transient lower oesophageal sphincter relaxations as the LOS has reduced tone thereby allowing gastric acid to flow back into the oesophagus
Clinical Presentation
Oesophageal
Food/acid brash (food, acid or bile regurgitation)
Water brash (increased salivation)
Belching
Odynophagia (painful swallowing)
Heartburn
Worse with hot drinks or alcohol
Seldom radiates to the arms
Burning chest pain that is aggravated by bending, stooping and lying down which promote acid exposure and may be relieved by antacids
Extra-oesophageal
Chronic cough
Laryngitis (hoarseness and throat clearing)
Nocturnal asthma
Sinusitis
Differentital Diagnosis
Peptic ulcer disease
Malignancy
Biliary colic
Coronary Artery Disease (CAD)
Diagnosis
Gastroscopy
Endoscopy (may be capsule)
Barium swallow
Treatment
Pharmacology
Alginates - relieves symptoms
Proton pump inhibitor - reduces gastric acid production
Antacids - relieve symptoms (if contain magnesium - may cause diarrhoea)
H2 receptor antagonists - blocks histamine receptors on parietal cells thereby reducing acid release
Surgery
Aims to laparoscopically increase the resting LOS pressure
Lifestyle changes
Smoking cessation
Small, regular meals
Encourage weight loss
Avoid; hot drinks, alcohol, citrus fruits and eating less than 3 hours before bed
Complications
Peptic stricture
Inflammation of the oesophagus resulting from gastric acid exposure resulting in the narrowing and thus stricture of the oesophagus
Barrett's oesophagus - the distal oesophageal epithelium undergoes METAPLASIA from squamous to columnar