Gastro-oesophageal reflux disease
Gastro-oesophageal reflux is also known as GORD (and in the U.S.A. as GERD which presumably rhymes with nerd).
There are multiple definitions in the literature. It is reflux of gastroduodenal contents into the oesophagus, causing symptoms that are sufficient to interfere with quality of life. However there should be objective evidence of such reflux, such as oesophagitis at endoscopy or demonstration of reflux by other investigations as the symptoms of GORD are non specific.
A common cause of dyspepsia.
In European populations 20–25% have symptoms of GORD, In primary care, up to 40% of those with GORD have oesophagitis on endoscopy, but most have endoscopy negative reflux disease.
- Genetic (twin studies)
- Calcium channel blockers
- Obesity is not proved (inconsistent evidence)
- Smoking (little evidence)
- Alcohol (little evidence)
- Particular foods (little evidence but individuals may find that coffee, mints, dietary fat, onions, citrus fruits, or tomatoes, may predispose to symptoms)
It is a chronic condition with relapse in up to 80% without medical treatment.
- see risk factors
- raising head of bed
- Mild disease may respond to antacids and alginates
- The main stay of treatment with severe symptoms are Proton pump inhibitors. NICE recommends full dose PPI treatment for 1-2 months initially with if necessary lower dose maintenance .
- Histamine H2-receptor antagonists work .
- prokinetic drugs such a metoclopramide or domperidone may be considered
- Sucralfate may have a role
- Carbenoxolone usefulness is severely limited by its side-effects and contraindications.
Multiple procedures but
- Open surgery and laparoscopic surgery are no better than each other and are no better than PPIs
- Endoluminal gastroplication is regarded as investigational in England and Wales