GORD

Question 1

what is GORD?

Answer 1

Gastro‐oesophageal refluxdisease(GORD)

Question 2

what is the pathophysiology of GORD?

Answer 2

Dysfunctional Lower Sphincter.
Gastro‐oesophageal refluxisthemovementofgastric contents into the esophagus. Gastric reflux is a normal thing, however, it becomes pathological when the gastric reflux becomes excessive.

Question 3

what are the other contributing mechanism the can cause GORD?

Answer 3

• Caffeine, alcohol, chocolate, fats can make reflux worse.
• Certain medications e.g. beta‐blockers, nitrates, calcium channel blockers.
  Impairedoesophageal peristalsis
  Hiatus hernia

Question 4

what are the symptoms of GORD?

Answer 4

• Heartburn/chest discomfort — Burning sensation or discomfort over the chest
• Regurgitation — Food or liquid coming back up into mouth
• Sour or bitter taste in mouth
• May be worse soon after eating or lying down (e.g. bed time)

Question 5

When to be concerned in GORD?

Answer 5

If symptoms do not settle with pharmacological treatment or there are alarm symptoms (red flags) patient may require investigation with a gastroscopy

Question 6

What is a gastroscopy?

Answer 6

The procedure is done under sedation.

Question 7

What are the complications of GORD?

Answer 7

Reflux oesophagitis
Peptic stricture
Barrett’s esophagus
Cancer– oesophageal adenocarcinoma

Question 8

what is Reflux esophageal?

Answer 8

Damage to oesophageal mucosa by reflux leading to inflammation, ulceration, and bleeding.

Question 9

what is peptic strictures?

Answer 9

Prolonged inflammation of oesophageal mucosa by reflux can lead to fibrosis and scarring

Question 10

What is Barrett’s esophagus?

Answer 10

Damage to the oesophageal epithelium by chronic acid exposure that leads to Oesophageal epithelium (squamous epithelium) transforms to become like gastric epithelium (columnar epithelium with goblet cells).

Question 11

what is the precursor of Barrett’s esophagus?

Answer 11

oesophageal adenocarcinoma

Question 12

How does Barrett’s present?

Answer 12

High risk of suspicion in:
–	Male, over 50
–	Increased BMI
–	Smoker
–	Chronic GORD, especially poorly controlled

Question 13

what are the things that can increase the risk of Barrett’s to cancer?

Answer 13

Smoking, alcohol, certain dietary food

Question 14

what are the alarm features in GORD?

Answer 14

• Haematemesis
• Odynophagia
• Dysphagia
• Vomiting
• Weight loss
• Not improving with proton pump inhibitor treatment