GORD in adults

Definition/diagnostic criteria: Gastro-oesophageal reflux disease (GORD) is a condition where acid from the stomach leaks up into the oesophagus. It is diagnosed based on the typical symptoms of heartburn and regurgitation. When typical symptoms are present, the diagnosis of GORD can often be made clinically. However, in cases of atypical symptoms or when complications are suspected, further investigations may be necessary. The Montreal definition is widely accepted, defining GORD as ‘a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications’.

Epidemiology: GORD affects a significant proportion of the population with a prevalence of around 20-30% of adults in the UK experiencing symptoms weekly. There is a slightly higher prevalence in Western populations, and incidence peaks in individuals aged 40-59.

Diagnosis

Clinical features: The hallmark symptoms of GORD are heartburn and acid regurgitation. Other symptoms may include chest pain, dysphagia (difficulty swallowing), and chronic cough. Atypical symptoms can include laryngitis, asthma, and enamel erosion among others.

Investigations: Investigations are usually reserved for atypical cases, when complications such as Barrett’s oesophagus are suspected, or the diagnosis is in doubt. Common investigations include:

• Endoscopy: Recommended for patients with alarm features or those unresponsive to initial treatment.
• Ambulatory pH monitoring: Considered the gold standard for diagnosing reflux in patients with non-erosive reflux disease.
• Oesophageal manometry: Primarily used to rule out motility disorders.

Typical abnormalities found in GORD include oesophagitis seen on endoscopy or abnormal acid exposure on pH monitoring.

Treatment: The approach to managing GORD involves lifestyle modifications and pharmacotherapy. Lifestyle interventions include dietary changes, weight reduction, and elevating the head of the bed. Pharmacological treatment typically starts with proton pump inhibitors (PPIs), as they are more effective than H2-receptor antagonists for symptom relief and healing of oesophagitis. Antacids and alginates may be used as required for relief of occasional symptoms. Treatment may be stepped down once symptom control is achieved.

Prognosis: The prognosis for GORD is generally good with appropriate management. However, it is often a chronic condition requiring long-term treatment, especially in those with severe oesophagitis or Barrett’s oesophagus. Complications can include oesophageal strictures, Barrett’s oesophagus, and, rarely, oesophageal adenocarcinoma.