What does GORD stand for?
Gastro-Oesophageal Reflux Disease
It involves dysfunctional relaxation of the lower oesophageal sphincter leading to acid reflux.
What is GORD?
dysfunctional relaxation of the lower oesophageal sphincter (LOS) leading to acid contents in the stomach to reflux to the oesophagus, causing heartburn.
What can unmanaged GORD lead to?
- Inflammation
- Oesophagitis
- Ulcerations
- Bleeding
These complications arise from repeated exposure to stomach acid.
What is the 3 roles of the lower oesophageal sphincter (LOS)?
- Controlled swallowing
- Part of peristalsis
- Complex nerve control
The LOS prevents acid reflux into the oesophagus.
Explain the pathophysiology of GORD
Transient lower oesophageal sphincter relaxations (TLOSR):
What happens to pH levels in GORD?
↑ in acid = ↓ in pH
This indicates increased acidity in the stomach.
What are transient lower oesophageal sphincter relaxations (TLOSR)** associated with?
- ↑ gastric pressure
- ↓ clearance of refluxed materials
- ↓ oesophageal mucosal resistance
These factors contribute to the severity of GORD.
List common symptoms of GORD.
- Heartburn
- Acid regurgitation/reflux
- Upper abdominal discomfort
- Bloating
- Chest pain
- Feeling full
Symptoms are usually chronic and relapsing.
What are some contributing factors of GORD?
- ↓ LOS pressure
- Direct irritates of mucosa
These factors can exacerbate GORD symptoms.
Give examples for ↓ LOS pressure in GORD?
Chocolate
Coffee, tea, cola
Garlic
Onions
Smoking (stimulates acid secretion)
Alcohol (stimulates acid secretion)
Fatty meals
Give examples for direct irritates of mucosa in GORD?
Tomato-based products
Coffee
Spicy
Citrus
NSAIDs, aspirin
Name some drugs that worsen LOS pressure.
- Alpha blockers
- Beta blockers
- NSAIDs
- CCBs
- Prostaglandins
- Theophylline
- Estrogen and progesterone
These medications can worsen GORD by relaxing the LOS.
What are the three classifications of GORD?
- Nonerosive reflux disease
- Erosive oesophagitis
- Barrett’s oesophagus
Barrett’s oesophagus increases the risk of cancer due to cellular damage.
What happens when the esophagus is repeatedly exposed to stomach acid?
pro-inflammatory cells and cytokines are recruited to the area causing complications.
What are some oesophageal complications of GORD?
- Oesophagitis
- Barrett’s oesophagus
- Oesophageal stricture disease
- Adenocarcinoma
These complications arise from chronic acid exposure.
What are some Extra-oesophageal complications:
- Chronic laryngitis
- Asthma/chronic cough
- Laryngeal
- Tracheal stenosis.
What are the clinical goals of therapy for GORD?
- Alleviate symptoms
- Diminish recurrence and duration of reflux
- Promote healing
- Prevent complications
These goals aim to improve patient quality of life.
What are the therapy goals for GORD?
- ↑ LOS pressure
- Improve acid clearance
- Improve gastric emptying
- Protect the oesophagus mucosa
- ↓ acidity of reflux
- ↓ gastric volume available to be refluxed
What are the three phases of treatment for GORD?
- Phase 1: Lifestyle + OTC
- Phase 2: Pharmacological intervention
- Phase 3: Surgical intervention
Treatment progresses based on severity and response.
What is the mechanism of antacids?
Neutralise stomach acid
Examples include magnesium, calcium, and aluminium.
Give examples of antacids.
Magnesium (diarrhoea), calcium, and aluminium (constipation)
True or false: Antacids promote gastric healing.
False
Give counselling points for antacids.
Take with food for a long duration of action because it can of gastric emptying.
What does simeticone do? and what is it?
Asilicon polymer that ↓ surface tension of GI gas bubbles
It facilitates the elimination of trapped wind.
