Gastro-oesophageal reflux disease (GORD; also known as GERD Gastro-esophageal reflux disease)
GORD is a common cause of dyspepsia. It is caused by leakage of stomach contents back into the oesophagus through the lower esophageal sphincter (acid reflux), and this induces corrosive damage to the oesophageal mucosa. GORD is characterised by an extended period (>4 weeks) of upper abdominal pain/discomfort, heartburn, regurgitation and nausea and/or vomiting. It can become a chronic condition. Factors that favour acid reflux include stress and anxiety, smoking and alcohol, trigger foods (e.g., coffee, chocolate, fatty foods which delay gastric emptying), obesity (increases intra-abdominal pressure), prescription drugs that relax the lower oesophageal sphincter (e.g., alpha-blockers, anticholinergics, benzodiazepines, beta-blockers, bisphosphonates, calcium-channel blockers, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), nitrates, theophyllines, tricyclic antidepressants), pregnancy and the presence of a hiatus hernia.
Initial treatment will include a review of any existing medications that are known to exacerbate symptoms and prescription of a proton-pump inhibitor (PPI) drug such as omeprazole, esomeprazole, lansoprazole, rabeprazole or pantoprazole for a period of 4–8 weeks. These drugs reduce gastric acid production, and allow the healing process to begin. Other antacids (simeticone, sodium bicarbonate, and alginates) may also be included to relieve symptoms. Any lifestyle factors (e.g. smoking, high alcohol intake, excess body mass) should be addressed, eating within 3 hours of bedtime should be discouraged and occasionally raising the head of the bed may reduce nocturnal symptoms.
For patients who experience refractory or recurrent disease despite adhering to PPI therapy, an extension of PPI treatment (including at an increased dose) can be initiated. This can be complemented with prescription of a histamine (H2)-receptor antagonist (e.g. ranitidine, cimetidine or famotidine) if oesophagitis has been confirmed. Long-tern PPI maintenance treatment may be required, and if this is the case patients should be screened annually to assess their symptoms, and to determine if stopping treatment might be appropriate.
Complications arising from long-term GORD include the development of oesophageal ulcers and oesophageal scarring and narrowing, that can make swallowing difficult. In rare cases surgery may be considered to correct any structural defect that's contributing to, or caused by chronic acid reflux. Barrett's oesophagus is a condition that can be precipitated after repeated episodes of GORD over many years. It is characterised by changes in the cells of the oesophageal epithelium. This should be monitored (usually by endoscopy every few years) as there's a small risk of the cellular changes transforming into oesophageal cancer.
Further details of PPIs, H2-receptor antagonist and agents used to treat other forms of dyspepsia are included in the Antisecretory drugs topic within the Drugs/Gastrointestinal system module.
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