Summary
Epidemiology
- GORD induced dyspepsia affects about 30% of the population
Aetiology
- Hiatus hernia
- Eating certain foods – fat, chocolate, caffeine
- Smoking
- Obesity
- Dysfunction of the lower oesophageal sphincter (LOS)
- Alcohol
Pathology
Acidic stomach contents will spill out of the stomach and back up the oesophagus. The presence of a
hiatus hernia increases the risk, but
not everyone with a hiatus hernia gets GORD.There will usually be a problem with the LOS whereby it doesn’t contract normally. Certain foods make the sphincter less likely to contract. There is also often
decreased gastric emptying.
The oesophagus may become inflamed, reddened and ulcerated, although the level of tissue damage is not related to the
severity of symptoms. In some cases, the normal squamous epithelium may be replaced by a
columnar epithelium, similar to that found in the stomach. This is known as
Barrett’s oesophagus.
Symptoms
Often asymptomatic, but symptoms may include:
- ‘Heartburn’ – retrosternal chest pain, particularly after eating. May be worse on lying down
- The pain is usually relieved by antacids
Investigations
In patients under 65 with no red flag symptoms, diagnosis is usually clinical. Otherwise, investigations may involve:
- Endoscopy
- Barium swallow – may shows the presence of a hiatus hernia, or strictures
Complications
- Anaemia – due to blood loss
- LOS stricture – due to fibrosis. Can cause a dysphagia that is worse for solids than liquids
Treatment
- Lose weight
- Stop smoking
- Reduce alcohol intake
- Avoid eating late at night
- Sleep with more pillow to keep the oesophagus higher than the stomach
- PPI’s
- Antacids
In severe cases, that fail to respond to the above methods, then surgery may be undertaken. Usually, part of the stomach is wrapped around the lower oesophagus to create a new functional sphincter. This procedure is known as a Nissen fundoplication.
Gastro-intestinal reflux disease is a condition characterised by retrosternal, and sometimes epigastric pain, as a result of reflux of the acidic contents of the stomach into the oesophagus.
Lots of people get GI symptoms with stress – however, this is not because stress causes these symptoms! Stress just changes your perception of symptoms.
It is often difficult to differentiate GORD from the symptoms of
MI, and many patients admitted to cardiac wards, are actually just suffering from GORD
Occasional feelings of ‘heartburn’ (dyspepsia) are normal. Acid reflux will cause peristaltic contraction of the oesophagus and alkaline saliva secretion, and normally this will cause the symptoms to go away.
It is only when pathological changes have occurred that allow gastric contents to be in prolonged contact with the oesophagus that we would call it GORD.
Epidemiology
- GORD resulting in heartburn affects about 30% of the population
Pathology
There are several mechanisms by which GORD can occur:
