Gastro-oesophageal reflux disease

Gastro-oesophageal reflux disease (GORD) is a clinical diagnosis. The classic symptoms are heartburn and regurgitation. A therapeutic trial of a proton-pump inhibitor (PPI) can serve for both diagnosis and initial treatment.

Upper endoscopy is indicated to evaluate for complications; for atypical, persistent, or relapsing symptoms; or for alarm features (e.g., weight loss, anaemia).

High rate of relapse upon stopping treatment.

Serious complications of GORD include stricture, Barrett's oesophagus, or oesophageal carcinoma.

Gastro-oesophageal reflux disease (GORD) is defined as 'the condition in which the reflux of gastric contents into the oesophagus results in symptoms and/or complications'.[1]Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56. https://journals.lww.com/ajg/fulltext/2022/01000/acg_clinical_guideline_for_the_diagnosis_and.14.aspx http://www.ncbi.nlm.nih.gov/pubmed/34807007?tool=bestpractice.com [2]Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006 Aug;101(8):1900-20. http://www.ncbi.nlm.nih.gov/pubmed/16928254?tool=bestpractice.com [3]Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008;135:1383-91. http://www.gastrojournal.org/article/S0016-5085%2808%2901606-5/fulltext http://www.ncbi.nlm.nih.gov/pubmed/18789939?tool=bestpractice.com

Typical symptoms are heartburn and acid regurgitation. Extra-oesophageal symptoms include cough, laryngitis, asthma, or dental erosion.[1]Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56. https://journals.lww.com/ajg/fulltext/2022/01000/acg_clinical_guideline_for_the_diagnosis_and.14.aspx http://www.ncbi.nlm.nih.gov/pubmed/34807007?tool=bestpractice.com ​​[4]Sidhwa F, Moore A, Alligood E, et al. Diagnosis and treatment of the extraesophageal manifestations of gastroesophageal reflux disease. Ann Surg. 2017 Jan;265(1):63-7. http://www.ncbi.nlm.nih.gov/pubmed/27455157?tool=bestpractice.com [5]Fass R. Gastroesophageal reflux disease. N Engl J Med. 2022 Sep 29;387(13):1207-16. http://www.ncbi.nlm.nih.gov/pubmed/36170502?tool=bestpractice.com [6]Chen JW, Vela MF, Peterson KA, et al. AGA clinical practice update on the diagnosis and management of extraesophageal gastroesophageal reflux disease: expert review. Clin Gastroenterol Hepatol. 2023 Jun;21(6):1414-21.e3. https://www.cghjournal.org/article/S1542-3565(23)00143-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/37061897?tool=bestpractice.com ​​ Atypical symptoms include dyspepsia, epigastric pain, nausea, bloating, and belching.[7]Gerson LB, Kahrilas PJ, Fass R. Insights into gastroesophageal reflux disease-associated dyspeptic symptoms. Clin Gastroenterol Hepatol. 2011 Oct;9(10):824-33. https://www.doi.org/10.1016/j.cgh.2011.05.015 http://www.ncbi.nlm.nih.gov/pubmed/21699806?tool=bestpractice.com

GORD may occur with or without oesophageal inflammation (oesophagitis). If erosions are present on endoscopic examination, the condition is called erosive reflux disease (ERD); if there are no erosions, it is called non-erosive reflux disease (NERD).[1]Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56. https://journals.lww.com/ajg/fulltext/2022/01000/acg_clinical_guideline_for_the_diagnosis_and.14.aspx http://www.ncbi.nlm.nih.gov/pubmed/34807007?tool=bestpractice.com