Gastro-oesophageal reflux disease (GORD)

Dyspepsia: upper abdominal discomfort/pain, often described as burning, heaviness or ache, often related to eating and may be accompanied by other symptoms such as nausea, fullness or belching.

GORD: reflux of gastric contents into the oesophagus, causing symptoms such as heartburn and acid regurgitation.


  •  More common in men than in women
  • Around 25% of adults experience heartburn and 5% have daily symptoms
    • Around a quarter of these patients will see a doctor.
  • More common in patients with asthma and more common in overweight individuals


  • Reduced lower oesophageal sphincter tone
  • Increase abdominal pressure
  • Smoking, alcohol, fatty foods, coffee
  • Pregnancy
  • Obesity
  • Tight clothes/big meals
  • Hiatus hernia; systemic sclerosis and post oesophageal surgery for achalasia


  • Heartburn/dyspepsia
    • Discomfort/pain may be epigastric, retrosternally or in the throat
    • Related to meals, and often made worse by lying down, stooping, straining etc
    • It may be relieved by certain drinks e.g. milk, or by antacids
  • Other symptoms include
    • “Acid brash”- acid reflux causing an acidic ‘taste’ in the back of the mouth
    • “Water brash”- essentially excess salivation (response of the salivary glands in response to acid in the gullet)
    • Odynophagia (painful swallowing) or dysphagia (feeling that the food is stuck in the gullet)
    • Food or acid reflux
  • Atypical features include
    • Chest pain- may be severe.  GORD can often mimic ACS, particularly in older patients
      • thought to perhaps be due to oesophageal spasm
    • Chronic hoarseness of the voice
    • recurrent chest infections
    • Chronic cough
    • Wheeze/shortness of breath
  • Examination is usually normal if symptoms are not present at the time.  They may or may not have a ‘tender’ epigastric area (palpation may worsen symptoms).

Differential Diagnosis

  • Peptic ulcer disease
  • Drugs e.g. NSAIDs
  • Infection (esp immunocompromised patients)
  • Oesophageal spasm
  • GI cancers


  • Bloods: FBC (?anaemia – peptic ulcer; leucopenia- infection
  • NB Many patients in whom there is a high clinical suspicion of GORD won’t require endoscopy, but for those with severe/problematic disease, or with red flag symptoms e.g. weight loss, dysphagia, anaemia, etc- further investigations may be used
  • Endoscopy is investigation of choice (NB can be normal)
    • NB This investigation may not show any abnormality (e.g. oesophagitis).  This DOES NOT exclude GORD as the diagnosis, it is mainly used for treatment planning (see below)
    • Patients should not have been taking any drugs that may contribute to symptoms for two weeks or more prior to endoscopy
  • You can also use pH measurements to check the acidity in the oesophagus/mouth
    • 24 hour pH monitoring- where the pH is <4 for >6-7% of the study time- suggestive of GORD
  • Urea breath test for H pylori infection can be used if a peptic ulcer is suspected
  • Finally, if there is suspicion of a motility disorder (e.g. if the patient is complaining more of dysphagia or odynophagia with reflux), consider imaging/manometry tests


  • If there are underlying causes and/or contributing factors, make sure to reverse these where possible e.g.
    • Drugs e.g. NSAIDs, calcium channel blockers, nitrates, theophyllines, bisphophonates, steroids
    • H pylori infection
    • Obesity
    • Diet (fatty food, spicy food, fizzy drinks etc) and eating before bed/large meals
    • Alcohol, smoking
  • Antacids/alginates e.g.
  • Proton pump inhibitors
    • trial for a minimum of 4 weeks at a reasonable dose then treat at the lowest therapeutic dose thereafter (if successful)
    • If the patient doesn’t have any relief, the dose can be doubled for a further month or an H2-receptor antagonist can tried
  • Other drugs that can be tried are prokinetics e.g. metoclopramide
  • Surgery may be used for patients with a hiatus hernia.  Occasionally, fundoplication can be performed in other patients with refractory symptoms.  However,


  • Barrett’s Oesophagus and Oesophageal adenocarcinoma
  • Oesophageal ulcers and/or haemorrhage
  • Oesophageal strictures
  • Aspiration pneumonia
  • Poor oral health (due to acid) e.g. caries/tooth decay, gingivitis, halitosis

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