Gastro Oesophageal Reflux Disease (GORD/ GERD)
Summary
Symptoms
Imaging: Endoscopy, barium swallow
Others: 24/24 oesophageal pH monitoring +/- manometry
Management
Conservative:
Symptoms
- Post prandial retrosternal burning discomfort (dyspepsia) relieved by antacids
- Worsened by lying
- Vomiting
- Belching
- Acid/ waterbrash
- Odynophagia
- Chronic cough
- Laryngitis
- Acidic food (fizzy drinks, citrus, tomatoes, spicy food)
- Obesity
- Pregnancy
- Meds (TCA, antiACh, NSAIDs, nitrates)
Imaging: Endoscopy, barium swallow
Others: 24/24 oesophageal pH monitoring +/- manometry
Management
Conservative:
- Raise bed head
- Weight loss
- SNAP
- Avoid hot drinks, citrus, tomatoes, fizzy drinks, spicy food, trigger meds
- Antacids (mg)
- PPI (more effective than H2 blockers)
- H2 blockers
- Inc resting lower oesophageal sphincter pressure
Definition
>/= 2 heartburn episodes/w
Aetiology
Clinical Features
Symptoms
Investigations
Imaging: Endoscopy if >4/52, barium swallow (hiatus hernia)
Others: 24/24 oesophageal pH monitoring +/- manometry
Management
Conservative:
Pharm
Surgery
Complications
Source
OHCM 9th Ed 2014
>/= 2 heartburn episodes/w
Aetiology
- Lower oesophageal sphincter hypotension
- Hiatus hernia
- Loss of oesophageal peristalsis
- Obesity
- Gastric acid hypersecretion
- Slow gastric emptying/ overeating
- Smoking/ Alcohol
- Pregnancy
- Achalasia
- Meds (TCA, antiACh, nitrates)
- (H pylori)
Clinical Features
Symptoms
- Post prandial retrosternal burning discomfort relieved by antacids
- Worsened by lying
- Vomiting
- Belching
- Acid/ waterbrash
- Odynophagia
- Chronic cough
- Laryngitis
Investigations
Imaging: Endoscopy if >4/52, barium swallow (hiatus hernia)
Others: 24/24 oesophageal pH monitoring +/- manometry
Management
Conservative:
- Raise bed head
- Weight loss
- SNAP
- Avoid hot drinks, citrus, tomatoes, fizzy drinks, spicy food, meds (TCA, antiACh, NSAIDs)
Pharm
- Antacids (mg)
- PPI (more effective than H2 blockers)
- H2 blockers
Surgery
- Inc resting lower oesophageal sphincter pressure
Complications
- Oesophagitis
- Benign oesophageal stricture
- Barrett's oesophagus (= premalignant)
Source
OHCM 9th Ed 2014