GORD

Gastroesophageal Reflux Disease (GORD), also known as acid reflux, is a common condition where stomach contents, including acid, flow back into the esophagus, causing a range of symptoms such as heartburn and regurgitation.The diagnosis and management of GORD follows evidence-based guidelines, which aim to provide effective symptom relief, heal esophagitis, and manage or prevent complications. Here’s a summary:

1. Diagnosis of GORD:
   
   1. Clinical Assessment: Initial diagnosis is often based on the patient’s history and clinical presentation. Classic symptoms include heartburn and acid regurgitation.
   2. Empirical Therapy: A trial of proton pump inhibitors (PPIs) is often initiated based on symptom presentation. Response to PPI therapy can support the diagnosis of GORD.
   3. Endoscopy: An upper gastrointestinal endoscopy is recommended for patients with red flag features (e.g., dysphagia, weight loss, anemia), those who do not respond to empirical treatment, or for the assessment of complications such as esophagitis or Barrett’s esophagus.
   4. Reflux Monitoring: Ambulatory pH or pH-impedance monitoring may be used in patients with non-erosive reflux disease or atypical symptoms, particularly when the diagnosis is uncertain or prior to anti-reflux surgery.
   5. Manometry: Esophageal manometry is not routinely used for GORD diagnosis but may be employed preoperatively or to assess for motility disorders.
2. Management of GORD:
   
   1. Lifestyle Modifications:
      • Diet and Lifestyle: Patients are advised to avoid foods and beverages that trigger symptoms, eat smaller meals, avoid lying down after eating, and elevate the head of the bed.
      • Weight Loss: For overweight or obese patients, weight loss is recommended as it can significantly reduce reflux symptoms.
   2. Pharmacotherapy:
      • Proton Pump Inhibitors (PPIs): These are the first-line treatment for GORD due to their efficacy in reducing gastric acid production. They are used for symptom relief and healing esophagitis.
      • H2-Receptor Antagonists: If PPIs are not available or not tolerated, H2-receptor antagonists can be used, although they are less effective.
      • Antacids and Alginate: These can be used for on-demand symptom relief but are not suitable for long-term monotherapy in GORD.
      • Prokinetics: May be considered as an adjunct to PPI therapy in patients with refractory symptoms, although the evidence for their efficacy is limited.
   3. Surgical and Endoscopic Treatment:
      • Anti-reflux Surgery: Surgical options, such as laparoscopic Nissen fundoplication, are considered for patients with refractory GORD, those with large hiatal hernias, or for those who prefer surgery over long-term medication.
      • Endoscopic Therapies: Procedures like radiofrequency ablation or endoscopic plication may be options for selected patients, but these are less common and not considered standard care.
3. Monitoring and Follow-up:
   • Treatment Review: Regular review of medication is important to assess symptom control, the need for ongoing treatment, and to minimize potential PPI side effects by using the lowest effective dose.
   • Barrett’s Esophagus Surveillance: For patients diagnosed with Barrett’s esophagus, a condition that can result from long-term GORD, regular surveillance endoscopy is recommended to monitor for dysplasia.
   • Management of Complications: Complications like strictures may require endoscopic dilation, and severe reflux can lead to conditions such as aspiration pneumonia or laryngitis, which require specific management.

In Australia, the management of GORD is also supported by resources and guidelines from organizations such as the Gastroenterological Society of Australia (GESA) and the Royal Australian College of General Practitioners (RACGP). These resources ensure that practitioners across the country have access to current best practices and standards for the diagnosis and treatment of GORD.