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Gastro-Oesophageal Reflux Disease

From Mediwikis

Patient with reflux of gastric contents into the oesophagus and persistant symptoms. Caused by decreased tone/increased pressure at the lower oesophageal sphincter, increased lower abdominal pressure, delayed gastric emptying and impaired oesophageal clearance.

Symptoms

  • Dyspepsia (group of symptoms):
    • Epigastric pain - can be related to hunger/eating/time of day
    • Retrosternal pain with demonstrable acid reflux (heartburn)
      • Aggravated by bending, stooping and lying down
      • Relieved by antacids
  • Odynophagia
  • Belching
  • Cough, Nocturnal Asthma - aspiration of gastric contents into lungs

Exclude ALARM symptoms

  • Anaemia (iron deficiency)
  • Loss of weight
  • Anorexia
  • Recent onset of progressive symptoms
  • Melaena / haematemesis
  • Swallowing difficulty

In Children

Common in infancy; should resolve by 12 months of age, GORD is caused by inappropriate relaxation of the lower oesophageal sphincter. Symptoms are also affected by supine position, liquid diet, and neurodevelopmental disorders (Cerebral Palsy)

Investigations

Usually none; only if severe or prolonged:

  • 24hr oseophageal pH monitoring
  • Endoscopy

Management

  • Self limiting- reassure parents
  • Sit upright
  • Thicken feeds
  • H2 receptor antagonists (Ranitidine)
  • Proton pump inhibitors (omeprazole)
  • Surgery

Investigation

If patient >45 years old, or ALARM symptoms:

  • Barium swallow
  • 24 hour intraluminal pH monitoring
  • Endoscopy

Treatment

  • Lifestyle advice - lose weight, stop smoking, eat fewer spicy foods
  • Antacids
  • H2 receptor antagonists (e.g. - Ranitidine)
  • Prokinetic agents (e.g. - Metaclopramide) - Not recommended as monotherapyy or as an adjunct in GORD
  • Proton Pump Inhibitors (e.g. - Lansoprazole) - MOST EFFECTIVE
  • Endoscopic therapy
  • Surgery

Complications

  • Oesophageal stricture
  • Metaplasia - Barrett's oesophagus
  • Dysplasia/Adenocarcinoma