Gastro-oesophageal reflux disease

Chronic reflux of gastric contents back into the oesophagus resulting Gastritis

“Proven GORD” refers to endoscopically determined reflux disease

Oesophagitis - when inflammation and mucosal erosions are seen Endoscopy - negative reflux disease (non-erosive reflux disease) symptoms but normal endoscopy

Barrett's oesophagus

10-15% of people with GORD will develop Barrett’s oesophagus and 1-10% will develop oesophageal adenocarcinoma over next 10-20 years

Causes/Factors

• Lifestyle factors - Obesity, trigger foods, smoking, alcohol, coffee and stress
• Drugs that decrease lower oesophageal sphincter pressure - CCBs, anti-cholinergics, theophylline, benzos and nitrates
• Pregnancy

Symptoms

• Heart burn
• Regurgitation - sour or bitter-tasting fluid in mouth
• Dysphagia
• Chest pain
• NSAIDs

Signs

• Inflammation and erosion on endoscopy
• Dental erosion - erosion of dental enamel due to recurrent regurgitation of acidic gastric contents
• Bloating
• Nocturnal cough

Investigations

• Endoscopy
• Oesophageal pH monitoring
• Oesophageal manometry - measurement of motility and lower oesophageal sphincter pressure
• Barium swallow - strictures or hiatal Hernias

Management

• Lifestyle measures - sleeping with head raised

• Stop exacerbating drgs

• Full-dose PPI for 4 weeks for proven GORD - 8 weeks for severe Oesophagitis

  • Consider a further 4 weeks if unresolved
  • H2 receptor antagonist reduce gastric acid secretion

• Dysplasia on biopsy requires endoscopic resection

Complications/red Flags

• Ruling out other diagnosis are important - cardiac or hepatobilliary disease can contribute to symptoms